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Epicardial adipose tissue volume increase in hemodialysis patients treated with sevelamer or calcium-based phosphate binders: a substudy of the Renagel in new dialysis trial

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Abstract

Background

In the general population and in hemodialysis patients epicardial adipose tissue (EAT) has been associated with increased mortality and cardiovascular events. Weight loss and lipid lowering therapies reduced EAT in the general population. It is unknown whether sevelamer, a phosphate (Pi) binder that lowers cholesterol and reduces inflammation in dialysis patients also affects EAT progression.

Methods

Post-hoc analysis of a randomized trial of sevelamer (SVL) versus calcium-based Pi binders (CPiB) in incident hemodialysis patients. EAT was measured on cardiac computed tomography scans performed at enrollment, 6, 12 and 18 months from baseline.

Results

Of 109 patients, 54 received SVL and 55 CPiB; the median LDL change was −16.4 % (IQR: −67.5, 142.3 %) and 12.1 % (IQR: −51.9, 193.8 %) with SVL and CPiB respectively (p < 0.001). At baseline EAT correlated significantly with gender, body mass index and total coronary artery calcium score (all p < 0.02). At the end of follow-up, EAT progressed significantly from baseline in the CPiB treated patients but not in the SVL treated patients [median increase 9.1 % (p = 0.005) vs 3.9 % (p = 0.25)]. However, there was no significant difference in the degree of progression between treatment groups (p = 0.34). There was no correlation between LDL or CRP change and EAT change. There were insufficient events in either arm to assess the impact of EAT change on mortality.

Conclusion

EAT progression from baseline was significantly smaller with SVL than with CPiB, although the difference between treatments was not statistically significant, probably due to the small sample size. Change in serum lipids and markers of inflammation did not predict EAT progression.

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Author information

Authors and Affiliations

  1. Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Sung Min Ko

  2. Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA

    Chao Zhang & Zhengjia Chen

  3. Hospital Residència Sant Camil, Ronda Sant Camil, 08810, Sant Pere de Ribes, Catalunya, Spain

    Luis D’Marco

  4. Clínica Puerto Ordaz, Unidad Avanzada de Investigación y Diagnostico Ecográfico y Renal, Puerto Ordaz, 8050, Venezuela

    Luis D’Marco

  5. Sant’ Anna Hospital, Como, Italy

    Antonio Bellasi

  6. University of Milan, Milan, Italy

    Antonio Bellasi

  7. Division of Cardiothoracic Imaging, Department of Radiology, Emory University, Atlanta, GA, USA

    Arthur E. Stillman & Paolo Raggi

  8. Denver Nephrology, Denver, CO, USA

    Geoffrey Block

  9. Mazankowski Alberta Heart Institute, University of Alberta School of Medicine, 8440-112 Street, Suite 4A7.050, Edmonton, AB, T6G2B7, Canada

    Paolo Raggi

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  1. Sung Min Ko
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  2. Chao Zhang
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  4. Luis D’Marco
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Corresponding author

Correspondence to Paolo Raggi.

Ethics declarations

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

Dr. Paolo Raggi and Dr. Geoffrey Block received an unrestricted grant from Genzyme Therapeutics to conduct the RIND study. Dr. Antonio Bellasi received honoraria for speaking engagements from Sanofi.

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Ko, S.M., Zhang, C., Chen, Z. et al. Epicardial adipose tissue volume increase in hemodialysis patients treated with sevelamer or calcium-based phosphate binders: a substudy of the Renagel in new dialysis trial. J Nephrol 29, 683–690 (2016). https://doi.org/10.1007/s40620-016-0310-9

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  • DOI: https://doi.org/10.1007/s40620-016-0310-9

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