Low Dose of Sevelamer is Enough to Prevent Coronary Artery Calcification Progression in Prevalent Hemodialysis Patients

Objective: Our objective is to study the possible role of low dose sevelamer hydrochloride on the rate of progression of coronary artery calcification among prevalent hemodialysis (HD) patients. Methods: Eighty HD patients were selected to this study. These patients were receiving oral calcium carbonate (CaCO3) as 200mg of elemental calcium with each meal (total of 1500 mg/day). They were randomized into two equal groups. The first group was administered sevelamer hydrochloride as 800 mg with each meal (2400 mg/day) instead of CaCO3 [Group I], while the oral CaCO3 was maintained as 200mg of elemental calcium with each meal in the 2nd group [Group II]. Coronary artery calcification score (CCs) was assessed before stating and at the end of the trial. In addition, serum fibroblast growth factor 23 (FGF23), calcium, phosphorus, lipids and intact parathyroid hormone (PTH) were estimated in these two events. Results: The baseline CCs and serum FGF23 were comparable in the 2 groups (200 ± 98.45 vs. 198 ± 69.68 A and 4669.5 ± 3540.9 vs. 4737 ± 2578.2 pg/ml, P=0.75 and 0.34 for CCs and serum FGF23 in group I vs. group II respectively). On the other hand, CCs and serum FGF23 were significantly lower in group I compared to group II by the end of the trial (203 ± 97.95 vs. 292 ± 100.16 A and 3011.8 ± 1853.7 vs. 7071.5 ± 2650.4 pg/ml, p= 0.012 and <0.001 for CCs and serum FGF23 in group I vs. group II respectively). These significant changes were associated with a highly significant decrease of CaxP product after using sevelamer (53.7 ± 6.5 vs. 65.3 ± 5.55, in group I vs. group II respectively, p<0.001). CCS showed significant correlation with FGF 23 (r=0.634, p<0.001) but failed to show similar correlation with other studied parameters in both groups. Conclusion: Low dose Sevelamer HCL can withhold coronary artery calcification progression in prevalent HD patients, and significantly decreases FGF 23 level. These results may help to overcome the patient intolerance and economic burden of the full dose of sevelamer. Further studies comparing low dose versus full dose of sevelamer are needed in these patients