A STUDY ON HYPERPHOSPHATEMIA AND EFFECT OF SEVELAMER ON CARDIAC ENZYME LEVELS IN CHRONIC KIDNEY DISEASE PATIENTS
Abstract
Objective: Chronic Kidney Disease (CKD) is characterized by progressive loss of kidney function over a period of time. Sevelamer hydrochloride is a phosphate binding agent used to control serum phosphate levels in End Stage Renal Disease (ESRD) patients with hyperphosphatemia. Since hyperphosphatemia is associated with acute myocyte injury and elevation of cardiac biomarkers. ESRD patients treated with sevelamer hydrochloride display reduced cardiac biomarker levels due to a decrease in serum phosphate. Therefore, the study was designed to evaluate the effect of sevelamer hydrochloride on cardiac enzyme levels.
Methods: This retrospective observational study was carried out in the nephrology department of a multispecialty hospital for a period of two months. Clinical and biochemistry reports of 30 ESRD patients were collected in designed case report forms. All statistical analysis was carried out using International Business Machines-Statistical Package for the Social Sciences, version 17 (IBM SPSS 17) Statistics package.
Results: No significant difference in cardiac enzymes between sevelamer-treated and untreated groups was observed. Hence, further prospective studies on sevelamer hydrochloride are necessary to determine their activity in preventing hyperphosphatemia-induced acute myocyte injury.
Conclusion: A direct correlation was observed between cardiac enzyme markers and phosphate levels. However, sevelamer at conventional doses was not found to be effective in reducing acute cardiomyocytes injury caused by hyperphosphatemia. Hence, higher doses sevelamer or other modalities achieving normal serum phosphorous levels are necessary for preventing cardiac damage due to hyperphosphatemia in ESRD patients.
Keywords: ESRD, Hyperphosphatemia, Sevelamer, Cardiomyocytes injury.
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References
Garabed E, Norbert L, Kai UE, Bertram LK, David CW, Michel J, et al. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150.
Robert CA. The epidemiology of chronic kidney disease. Kidney Int 2005;67:14-8.
Robert T, Abbas K, John RS. Chronic kidney disease and its complications. Prim Care 2008;35:329–37.
Keith AH, Suresh M, Richard L, Ping Q, Raymond P. Hyperphosphatemia of chronic kidney disease. Kidney Int 2008;74:148-57.
Shu W, Ling Q, Tianfu W, Bingqing D, Yuerun S, Dayong H, et al. Elevated cardiac markers in chronic kidney disease as a consequence of hyperphosphatemia-induced cardiac myocyte injury. Med Sci Monit 2014;20:2043-53.
Anjay Rastogi. Sevelamer revisited: pleiotropic effects on endothelial and cardiovascular risk factors in chronic kidney disease and end-stage renal disease. Ther Adv Cardiovasc Dis 2013;7:322–42.
Lee DB, Goodman WG, Coburn JW. Renal osteodystrophy: some new questions on an old disorder. Am J Kidney Dis 1988;11:365-76.
Goldsmith D, Covic A. Oral phosphate binders in CKD-is calcium the (only) answer? Clin Nephrol 2014;81:389-95.
Andrew SL, Josef C, Ethan B, Annamaria TK, Adeera L, Michael WS, et al. National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47.
Rosemarie LS, Ann M. Rate of decline in eGFR and clinical evaluation of the elderly with a low eGFR. American Society of Nephrology: Geriatric Nephrology Curriculum; 2009.
Narinder PS, Gopal KI, Vinay KS, Ajita J, Pankaj B, Madan L, et al. Prevalence of low glomerular filtration rate, proteinuria and associated risk factors in North India using Cockcroft-gault and modification of diet in renal disease equation: an observational, cross-sectional study. BMC Nephrol 2009;10:4.
Jose ML, Carlos M, Ana BR, Francisco JL. Common pathophysiological mechanisms of chronic kidney disease: Therapeutic perspectives. Pharmacol Ther 2010;128:61–81.
Colin DC, Jonathan NT, Richard PS, Charles JF. Evaluating the effects of sevelamer carbonate on cardiovascular structure and function in chronic renal impairment in birmingham: the CRIB-PHOS randomised controlled trial. Trials 2011;12:30.