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Effects of sevelamer hydrochloride on mortality, lipid abnormality and arterial stiffness in hemodialyzed patients: a propensity-matched observational study

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Abstract

Background

Cause-and-effect associations between sevelamer hydrochloride (HCl) and mortality have yet to be clarified. The effects of sevelamer HCl on mortality, lipid abnormality and arterial stiffness were examined in patients with chronic kidney disease stage 5D.

Methods

The effects of sevelamer HCl were studied by a single-center cohort study that was conducted from January 1, 2005 to December 31, 2008 (n = 483). By the end of the study, 172 patients (Sevelamer group) had succeeded in continuing sevelamer HCl for >6 months (median 37 months), and 300 patients (Control group) had received calcium carbonate (n = 264) or no phosphate binder (n = 36). The mortality and other outcomes were compared between these two groups after matching by a propensity score calculated using age, gender, diabetes prevalence, and dialysis vintage.

Results

All-cause [hazard ratio (HR) 0.4, P = 0.02] and cardiovascular (CV)-cause [HR 0.29, P = 0.03] cumulative mortality were significantly lower in the matched Sevelamer group than in the matched Control group. The matched Sevelamer group showed increased high-density lipoprotein cholesterol (P = 0.003) and no change in pulse wave velocity (PWV) and ankle-brachial index (ABI), whereas the matched Control group showed increased serum low-density lipoprotein (LDL) cholesterol (P = 0.003), increased PWV (P = 0.03), and decreased ABI (P = 0.0009). Change in serum LDL cholesterol level correlated inversely with sevelamer HCl dosage (P = 0.02).

Conclusions

Reduced mortality in patients with sevelamer HCl may, at least in part, be explained by an improvement in dyslipidemia and arterial stiffness by sevelamer HCl.

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Acknowledgments

The authors wish to thank the patients and health-care providers at our dialysis unit who participated in this study. We are very grateful to Ms. Kayoko Motoyama for her assistance with statistical analyses.

Conflict of interest

Yusuke Tsukamoto have received honorarium for the lecture from Chugai Pharma Co, Kyowahakko-Kirin Co and Bayer Yakuhin Ltd.

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Authors and Affiliations

  1. Department of Nephrology, Shuwa General Hospital, Saitama, Japan

    Soichiro Iimori, Yoshihiro Mori, Wataru Akita, Shigeru Takada, Tamaki Kuyama, Tsuyoshi Ohnishi, Satomi Shikuma, Junichi Ishigami, Masato Tajima, Tomoki Asai, Tomokazu Okado, Michio Kuwahara & Yusuke Tsukamoto

  2. Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Soichiro Iimori, Tomokazu Okado & Sei Sasaki

Authors
  1. Soichiro Iimori
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  2. Yoshihiro Mori
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  3. Wataru Akita
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  4. Shigeru Takada
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  5. Tamaki Kuyama
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  6. Tsuyoshi Ohnishi
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  7. Satomi Shikuma
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  8. Junichi Ishigami
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  9. Masato Tajima
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  10. Tomoki Asai
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  11. Tomokazu Okado
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  12. Michio Kuwahara
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  13. Sei Sasaki
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  14. Yusuke Tsukamoto
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Corresponding author

Correspondence to Soichiro Iimori.

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Iimori, S., Mori, Y., Akita, W. et al. Effects of sevelamer hydrochloride on mortality, lipid abnormality and arterial stiffness in hemodialyzed patients: a propensity-matched observational study. Clin Exp Nephrol 16, 930–937 (2012). https://doi.org/10.1007/s10157-012-0640-4

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  • DOI: https://doi.org/10.1007/s10157-012-0640-4

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