Effects of sevelamer: A Synthesis of Findings from 17 Studies

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Original Abstract of the Article

Major Research Findings

Sevelamer is a medication used to treat high phosphorus levels in the blood (hyperphosphatemia) in patients with chronic kidney disease (CKD). It works by binding to phosphorus in the gut, preventing it from being absorbed into the bloodstream. Research has explored the diverse effects of sevelamer in CKD patients. 11 suggested that switching from sevelamer hydrochloride to bixalomer might lead to lower blood phosphorus levels. However, it was also found that bixalomer might be less effective than sevelamer hydrochloride in improving lipid metabolism. 15 demonstrated that sevelamer was effective in improving hyperphosphatemia in CKD patients compared to placebo. Furthermore, sevelamer's influence on bone metabolism in CKD patients was observed. 4 showed that sevelamer was more effective than sucroferric oxyhydroxide in improving bone metabolism in CKD patients. Sevelamer might also contribute to improving proteinuria in CKD patients. 3 suggested that sevelamer could potentially improve proteinuria in CKD patients. However, 17 found no definitive evidence that sevelamer improves cardiovascular health in CKD patients. The effects of sevelamer on the gastrointestinal system were also assessed. 13 showed that sevelamer could influence the pharmacokinetics of cinacalcet. 10 suggested that sevelamer could improve blood sugar levels in patients with diabetic kidney disease. 1 confirmed that sevelamer was more effective than other phosphate binders in improving blood sugar and lipid metabolism. 2 suggested that sevelamer might help slow down vascular calcification in patients receiving peritoneal dialysis. Additionally, sevelamer was found to be more effective than other phosphate binders in preventing vascular calcification in a rat model of chronic kidney failure. 8 also showed that sevelamer was more effective than other phosphate binders in preventing vascular calcification in a rat model of chronic kidney failure. Sevelamer might also reduce the activity of vitamin D receptor agonists in CKD patients. 7 suggested that sevelamer might reduce the activity of vitamin D receptor agonists in CKD patients. 16 showed that sevelamer was more effective than other phosphate binders in improving bone metabolism in CKD patients. 5 showed that sevelamer, acting as a bile acid sequestrant, can effectively lower blood sugar levels. 9 demonstrated that sevelamer had less of a negative impact on the stomach compared to other phosphate binders. 14 suggested that sevelamer might reduce uremic toxin levels in the blood of CKD patients. 6 suggested that sevelamer might reduce the levels of indoxyl sulfate and p-cresyl sulfate in the blood of CKD patients.

Benefits and Risks

Benefits Summary

Numerous studies indicate that sevelamer is effective in treating hyperphosphatemia in CKD patients. By inhibiting phosphorus absorption, sevelamer aims to lower blood phosphorus levels, potentially delaying CKD progression. Sevelamer also holds promise in improving lipid metabolism, blood sugar levels, bone metabolism, and uremic toxin levels in CKD patients.

Risks Summary

While generally considered safe, sevelamer can cause side effects such as constipation, diarrhea, indigestion, bloating, nausea, and vomiting. It might also hinder vitamin D absorption, increasing the risk of osteoporosis. As sevelamer may interact with other medications, consult your doctor before taking it.

Comparison Across Studies

Similarities

These studies generally suggest that sevelamer is effective in treating hyperphosphatemia in CKD patients. They also indicate that sevelamer could potentially improve lipid metabolism, blood sugar levels, bone metabolism, and uremic toxin levels compared to other phosphate binders.

Differences

These studies employ diverse research designs, evaluation criteria, and patient populations to assess sevelamer's effects. Therefore, drawing definitive conclusions about sevelamer's efficacy is challenging. For example, 11 compared sevelamer to bixalomer, 15 compared sevelamer to placebo, and 4 compared sevelamer to sucroferric oxyhydroxide.

Consistency and Contradictions in Results

While numerous studies suggest that sevelamer is effective in treating hyperphosphatemia in CKD patients, its other effects may exhibit inconsistencies across research findings. For instance, 17 did not find conclusive evidence regarding sevelamer's impact on cardiovascular health. Similarly, research findings on sevelamer's interference with vitamin D absorption remain inconsistent. Further investigation is needed to resolve these contradictions.

Considerations for Real-World Application

While sevelamer is used to treat hyperphosphatemia in CKD patients, it can cause side effects such as constipation, diarrhea, indigestion, bloating, nausea, and vomiting. It may also hinder vitamin D absorption, increasing the risk of osteoporosis. Therefore, it's crucial to consult your doctor before taking sevelamer.

Limitations of Current Research

These studies assess various effects of sevelamer, but they are all conducted using specific research designs, evaluation criteria, and patient populations. This makes it difficult to draw firm conclusions about sevelamer's efficacy. Additionally, these studies do not evaluate the long-term effects of sevelamer. Further research is required to understand the long-term safety and efficacy of sevelamer.

Future Research Directions

While sevelamer has shown effectiveness in treating hyperphosphatemia in CKD patients, additional research is warranted to further investigate its other effects. Particularly, further studies are needed to explore sevelamer's impact on cardiovascular health, vitamin D absorption, bone metabolism, uremic toxin levels, and its long-term safety and efficacy.

Conclusion

Numerous studies indicate that sevelamer is an effective medication for treating hyperphosphatemia in CKD patients. By inhibiting phosphorus absorption, sevelamer aims to lower blood phosphorus levels, potentially delaying CKD progression. Sevelamer also holds promise in improving lipid metabolism, blood sugar levels, bone metabolism, and uremic toxin levels in CKD patients. However, it's important to note that sevelamer can cause side effects such as constipation, diarrhea, indigestion, bloating, nausea, and vomiting. Additionally, it might hinder vitamin D absorption, increasing the risk of osteoporosis. Therefore, consult your doctor before taking sevelamer. Further research is needed to comprehensively understand the diverse effects of sevelamer.

Literature analysis of 17 papers
Positive Content
16
Neutral Content
1
Negative Content
0
Article Type
9
1
1
2
17
1.

Systematic review and meta-analysis of potential pleiotropic effects of sevelamer in chronic kidney disease: Beyond phosphate control.

Author: BasutkarRoopa Satyanarayan, VargheseResia, MathewNina Kallanthanath, Sankar IndiraPrithika, ViswanathanBalasubramaniam, SivasankaranPonnusankar

Blood glucose control
Inflammation reduction
Lipid panel improvement

This systematic review and meta-analysis compared the pleiotropic effects of sevelamer, a phosphate binder, to other phosphate binders used in chronic kidney disease patients. The study found that sevelamer may have beneficial effects on lipid profiles and blood glucose levels.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

3.

Effects of Sevelamer Carbonate in Patients With CKD and Proteinuria: The ANSWER Randomized Trial.

Author: RuggieroBarbara, TrilliniMatias, TartaglioneLida, RotondiSilverio, PerticucciElena, TripepiRocco, AparicioCarolina, LecchiVeruska, PernaAnnalisa, PeraroFrancesco, VillaDavide, FerrariSilvia, CannataAntonio, MazzaferroSandro, MallamaciFrancesca, ZoccaliCarmine, BellasiAntonio, CozzolinoMario, RemuzziGiuseppe, RuggenentiPiero, KohanDonald E,

Reduced proteinuria

This study investigated whether the phosphate binder sevelamer carbonate could enhance the antiproteinuric effect of renin-angiotensin system (RAS) inhibitors in patients with chronic kidney disease (CKD).

Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Effects of sucroferric oxyhydroxide and sevelamer carbonate on chronic kidney disease-mineral bone disorder parameters in dialysis patients.

Author: KettelerMarkus, SpragueStuart M, CovicAdrian C, RastogiAnjay, SpinowitzBruce, RakovViatcheslav, WalpenSebastian, FloegeJürgen

CKD-MBD management
Hyperphosphataemia treatment

This post-hoc analysis of a randomized, Phase 3 study evaluated the effects of 1-year treatment with sucroferric oxyhydroxide or sevelamer carbonate on chronic kidney disease-mineral and bone disorder (CKD-MBD) indices among dialysis patients with hyperphosphataemia.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

Glucose-lowering effects and mechanisms of the bile acid-sequestering resin sevelamer.

Author: BrøndenAndreas, MikkelsenKristian, SonneDavid P, HansenMorten, VåbenChristoffer, GabeMaria N, RosenkildeMette, TremaroliValentina, WuHao, BäckhedFredrik, RehfeldJens F, HolstJens J, VilsbøllTina, KnopFilip K

Glucose lowering

This study aims to investigate the glucose-lowering effect and mechanism(s) of sevelamer, a non-absorbable amine-based resin used for treatment of hyperphosphataemia, in patients with type 2 diabetes.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Effects of Sevelamer Hydrochloride on Uremic Toxins Serum Indoxyl Sulfate and P-Cresyl Sulfate in Hemodialysis Patients.

Author: LinCheng-Jui, PanChi-Feng, ChuangChih-Kuang, LiuHsuan-Liang, HuangSung-Fa, ChenHan-Hsiang, WuChih-Jen

Anti-inflammation
Reduced cholesterol

Sevelamer is a drug used to treat high levels of phosphate in the blood. This study looked at the effects of sevelamer on the levels of indoxyl sulfate and p-cresyl sulfate, two uremic toxins that build up in the blood of people with kidney failure.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

7.

Pharmacodynamic Effects of Sucroferric Oxyhydroxide and Sevelamer Carbonate on Vitamin D Receptor Agonist Bioactivity in Dialysis Patients.

Author: SpragueStuart M, CovicAdrian C, FloegeJürgen, KettelerMarkus, BothaJaco, ChongEdward M, RastogiAnjay

VDRA activity
Therapeutic activity
VDRA activity

This post hoc analysis of a Phase 3 study evaluated the pharmacodynamic effects of the iron-based phosphate binder sucroferric oxyhydroxide (SFOH) and sevelamer (SEV) carbonate on VDRA activity in dialysis patients.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

8.

Effects of Sucroferric Oxyhydroxide Compared to Lanthanum Carbonate and Sevelamer Carbonate on Phosphate Homeostasis and Vascular Calcifications in a Rat Model of Chronic Kidney Failure.

Author: PhanOlivier, MaillardMarc, MallucheHartmut H, StehleJean-Christophe, FunkFelix, BurnierMichel

Control hyperphosphatemia
Control secondary hyperparathyroidism
Prevent vascular calcifications

This study compared the effects of sucroferric oxyhydroxide (PA21), lanthanum carbonate (La), and sevelamer carbonate (Se) on serum FGF23, phosphorus, calcium, and iPTH in adenine-induced chronic renal failure rats. PA21 was associated with significantly decreased FGF23, while all three phosphate binders controlled hyperphosphatemia, secondary hyperparathyroidism, and vascular calcifications.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

9.

Sevalamer Hydrochloride, Sevelamer Carbonate and Lanthanum Carbonate: In Vitro and In Vivo Effects on Gastric Environment.

Author: CoppolinoGiuseppe, LucisanoSilvia, RivoliLaura, FuianoGiorgio, VillariAntonino, VillariIole, LeonelloGrazia, LacquanitiAntonio, SantoroDomenico, BuemiMichele

Phosphate binding
Constipation
Gastric intolerance

Sevelamer carbonate (SC) is the most effective phosphate binder for hyperphosphatemia in hemodialysis patients, offering rapid phosphorus chelation and good tolerability. While Sevelamer HCl has the best tolerability, lanthanum carbonate (LC) has the slowest dissolution rate and is associated with the most gastric irritation.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Effects of sevelamer carbonate on advanced glycation end products and antioxidant/pro-oxidant status in patients with diabetic kidney disease.

Author: Yubero-SerranoElena M, WoodwardMark, PoretskyLeonid, VlassaraHelen, StrikerGary E,

Improved HbA1c
Reduced AGEs

This study examined the effects of sevelamer carbonate (SC) on various biomarkers in patients with type 2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD). While SC did not significantly reduce advanced glycation end products (AGEs), it did increase antioxidant defenses and reduce pro-oxidants.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

11.

Clinical effects of the new phosphorus binder, bixalomer in hemodialysis patients switched from sevelamer hydrochloride.

Author: GenShikou, SasakiTakaya, SaitoKanako, NobeKanako, NodairaYuka, IkedaNaofumi

Reduced serum P

Switching from sevelamer hydrochloride to bixalomer in hemodialysis patients significantly reduced serum phosphorus levels without affecting gastrointestinal symptoms.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

Effects of switching from sevelamer hydrochloride to bixalomer on laboratory parameters in hemodialysis patients.

Author: FurukawaKazunori, IkawaTomoyoshi, YokoiSayuri, YokouchiShuhei, KatoKieko, UenoMiki, TakahashiJunichiro

Reduced serum P
Higher LDL-C
Lower HDL-C

Switching from sevelamer hydrochloride to bixalomer in hemodialysis patients significantly reduced serum phosphorus levels, but also required higher bixalomer dosages and had a potential negative effect on lipid metabolism.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Effects of calcium carbonate, sevelamer hydrochloride or pantoprazole on the pharmacokinetics of cinacalcet.

Author: PadhiDesmond, HarrisRobert, SullivanJohn T

Secondary hyperparathyroidism treatment

This study assessed the effects of calcium carbonate, sevelamer hydrochloride, and pantoprazole sodium on the pharmacokinetics and safety of cinacalcet in healthy subjects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

15.

The effects of colestilan versus placebo and sevelamer in patients with CKD 5D and hyperphosphataemia: a 1-year prospective randomized study.

Author: LocatelliFrancesco, SpasovskiGoce, DimkovicNada, WannerChristoph, DellannaFrank, PontorieroGiuseppe

Cholesterol reduction
Hyperphosphataemia treatment
Phosphorus reduction

This study compared the effects of short-term titrated colestilan, a non-absorbable, non-calcium phosphate binder, to placebo and sevelamer in patients with chronic kidney disease (CKD) 5D. The study found that colestilan was effective and safe for the treatment of hyperphosphataemia in patients with CKD 5D and afforded similar long-term phosphorus and cholesterol reductions/responder rates to sevelamer.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

A comparison of calcium acetate/magnesium carbonate and sevelamer-hydrochloride effects on fibroblast growth factor-23 and bone markers: post hoc evaluation from a controlled, randomized study.

Author: CovicAdrian, Passlick-DeetjenJutta, KroczakMiroslaw, Büschges-SeraphinBeatrix, GhenuAdrian, PoncePedro, MarzellBarbara, de FranciscoAngel L M

Phosphate binders for bone mineral metabolism

This study compared the effects of calcium acetate/magnesium carbonate (CaMg) and sevelamer-hydrochloride (HCl) on serum levels of fibroblast growth factor-23 (FGF-23) and bone turnover markers.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

17.

Cardiovascular effects of sevelamer in stage 3 CKD.

Author: ChueColin D, TownendJonathan N, MoodyWilliam E, ZehnderDaniel, WallNadezhda A, HarperLorraine, EdwardsNicola C, SteedsRichard P, FerroCharles J

Cardiovascular mortality prediction

This study investigated the effects of sevelamer carbonate, a phosphate binder, on left ventricular mass, function, and arterial stiffness in patients with stage 3 nondiabetic CKD. The study found no significant differences between sevelamer and placebo in these outcomes.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

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