Sevelamer Improves Oxidative Stress in Hemodialysis Patients

San Diego—Oxidative stress was improved in patients on maintenance hemodialysis with the use of sevelamer hydrochloride in a study conducted recently by Siren Sezer, MD, and colleagues. Study results were presented during a poster session at Kidney Week 2015 in a poster titled Sevelamer Hydrochloride Improves Oxidative Stress in Maintenance Hemodialysis Patients.

Oxidative stress has an important role in the pathogenesis of cardiovascular diseases. Superoxide (SOD) and malondialdehyde (MDA) are antioxidant enzymes that detoxify advanced glycation end products (AGEs). The researchers hypothesized that avoiding calcium intake and through pleiotropic effects, sevelamer hydrochloride might be a differential influence in oxidative stress. They designed the current study to examine the effects of phosphate binders on the components of the oxidative stress and clinical and biochemical parameters, including pulse wave velocity in patients on maintenance hemodialysis.

The study enrolled 111 patients undergoing maintenance hemodialysis and using the same phosphate binders for at least 1 year. Mean age of participants was 52.2 years; mean duration of dialysis was 9.7 years. The patients were divided into two groups according to use of phosphate binders. Group 1 was sevelamer based (n=84) and group 2 was calcium based (n=27). Biochemical parameters were assessed at monthly clinical visits. Serum AGE, MDA, and Sod levels were determined by enzyme-linked immune sorbent assay (ELISA) method. Pulse wave velocity was assessed using the SphygmoCor system.

Demographic characteristics and urea reduction ratio levels were similar in the two groups. Patients in group 1 had significantly lower AGE levels, and higher MDA and SOD levels (P=.018, P=.027, and P=.012, respectively), compared with patients in group 2. Baseline and first-year pulse wave velocity values were similar in the two groups; however, pulse wave velocity values decreased significantly in group 1 (P=.001) and increased in group 2 (P=.021) in the second year of dialysis.

“Despite similar phosphorus levels and dialysis adequacy, sevelamer decreases serum AGE and increased serum MDA and SOD levels as well as improves pulse wave velocity. Thus, sevelamer improves the oxidative stress and cardiovascular risk by pleiotropic effects when compared to calcium based phosphate binders,” the researchers said.

Source: Sezer S, Gurlekdemirci, Sayin CB, et al. Sevelamer hydrochloride improves oxidative stress in maintenance hemodialysis patients. Abstract of a poster presented during American Society of Nephrology Kidney Week 2015, November 6, 2015, San Diego, California.