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Sevelamer Carbonate: A Review in Hyperphosphataemia in Adults with Chronic Kidney Disease

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Abstract

Sevelamer carbonate (Renvela®), a buffered form of sevelamer hydrochloride (Renagel®), is an orally administered non-absorbed phosphate-binding anion exchange resin used in the treatment of hyperphosphataemia in chronic kidney disease (CKD). In the EU, sevelamer carbonate is approved in adult CKD patients who require dialysis and in those who do not require dialysis with serum phosphate levels ≥1.78 mmol/L, whereas in the USA sevelamer carbonate is approved in adult CKD patients who require dialysis. Sevelamer carbonate and sevelamer hydrochloride achieved similar reductions in serum phosphate levels in randomized comparative trials in patients with CKD receiving haemodialysis; sevelamer carbonate also reduced serum phosphate levels in noncomparative studies in CKD patients not requiring dialysis. The most common adverse events with sevelamer carbonate are gastrointestinal in nature. Sevelamer has pleiotropic effects, such as improving the serum lipid profile and attenuating endothelial and cardiovascular risk factors in CKD. All formulations of sevelamer have markedly higher acquisition costs than calcium-based phosphate binders. Cost-effectiveness analyses focusing specifically on sevelamer carbonate have not been conducted, and those based on clinical trial data with sevelamer hydrochloride have provided both favourable and unfavourable results compared with calcium-based phosphate binders, reflecting heterogeneity between modelled analyses in terms of data sources, assumptions, comparators, geographical regions, type of costs included and other factors. Although well-designed studies evaluating the impact of phosphate binders on hard clinical endpoints appear to be warranted, sevelamer carbonate may be particularly useful for the treatment of patients at risk of metabolic acidosis (offering advantages over sevelamer hydrochloride in this regard) and for individuals requiring treatment with a phosphate binding agent that does not contain aluminium or calcium.

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Disclosure

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on the article. Changes based on any comments received were made by the authors on the basis of scientific and editorial merit. Caroline Perry and Greg Plosker are salaried employees of Adis/Springer.

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    Caroline M. Perry & Greg L. Plosker

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  1. Caroline M. Perry
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Correspondence to Greg L. Plosker.

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The manuscript was reviewed by: P. Biggar, Nephrology Department, Klinikum Coburg, Coburg, Germany; L. De Nicola, Scienze Mediche, Chir., Neurol, Metab. e Invecchiamento, Nephrology-Second University of Naples, Naples, Italy; F. Locatelli, Department of Nephrology, Dialysis and Renal Transplantation, A Manzoni Hospital, Lecco, Italy; F. Malberti, Nephrology and Dialysis Unit, Istituti Ospitalieri Cremona, Cremona, Italy; P. Messa, Nephrology, Urology and Renal Transplant Unit, Fondazione Ca’ Granda IRCCS Policlinico, Milan, Italy.

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Perry, C.M., Plosker, G.L. Sevelamer Carbonate: A Review in Hyperphosphataemia in Adults with Chronic Kidney Disease. Drugs 74, 771–792 (2014). https://doi.org/10.1007/s40265-014-0215-7

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