Kidney Week

Abstract: SA-PO395

Protein-Bound Uremic Toxin-Lowering Effects of Sevelamer in Patients on Chronic Hemodialysis with Hyperphosphatemia: A Multicenter Randomized Controlled Trial: A Preliminary Report

Session Information

• Hemodialysis and Frequent Dialysis - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Srifa, Napas, King Chulalongkorn Memorial Hospital Department of Internal Medicine, Bangkok, Bangkok, Thailand

Napas Srifa, MD

• Phannajit, Jeerath, King Chulalongkorn Memorial Hospital Department of Internal Medicine, Bangkok, Bangkok, Thailand

Jeerath Phannajit, MD

• Lekhyananda, Sookruetai, Priest Hospital, Bangkok, Bangkok, Thailand

Sookruetai Lekhyananda, DrMed

• Chongthanakorn, Kamonrat, Charoenkrung Pracharuk Hospital, Bangkok, Bangkok, Thailand

Kamonrat Chongthanakorn

• Thamratnopkoon, Sipanan, Charoenkrung Pracharuk Hospital, Bangkok, Bangkok, Thailand

Sipanan Thamratnopkoon, MD

• Wathanavasin, Wannasit, Charoenkrung Pracharuk Hospital, Bangkok, Bangkok, Thailand

Wannasit Wathanavasin, MD, MSc

• Avihingsanon, Yingyos, King Chulalongkorn Memorial Hospital Department of Internal Medicine, Bangkok, Bangkok, Thailand

Yingyos Avihingsanon, MD

• Eiam-Ong, Somchai, King Chulalongkorn Memorial Hospital Department of Internal Medicine, Bangkok, Bangkok, Thailand

Somchai Eiam-Ong, MD

• Susantitaphong, Paweena, King Chulalongkorn Memorial Hospital Department of Internal Medicine, Bangkok, Bangkok, Thailand

Paweena Susantitaphong, MD, PhD

Background

P-cresol (pCS) is an important protein-bound uremic toxin (PBUT) linked with cardiovascular mortalites in chronic hemodialysis patients. Dialysis modalities have a limitation in removing PBUTs. Recent approaches focus on decreasing toxin generation, increasing gut absorbent, and preserving residual kidney function (RKF). Sevelamer, used as a phosphate binder, has limited data on pleiotropic effects on PBUTs in these patients. This study investigated the pCS-lowering effect of sevelamer in a open-label multicenter randomized controlled trial (TCTR20230530004).

Methods

Chronic hemodialysis patients with persistent hyperphosphatemia were randomly assigned to receive either sevelamer or calcium carbonate for 24-week using protocol-based dosage titration to achieve the target phosphate of 3.5-5.5 mg/dL. Blood samples were collected before and at 8, 16, 24 weeks. Mean differences between two groups including sub-group analysis stratified by RKF, phosphate binders dose, HD frequency, mean phosphate level and protein intake were analyzed using linear mixed model.

Results

Of the 73 initial participant, 3 patients dropped out leaving 35 in both treatment groups for the per-protocol analysis. Fifty-five percent were anuric (RKF < 100 ml/day). Significant phosphate lowering was observed in both groups. The mean changes in pCS were not different between groups. Interestingly, a trend towards reducing serum pCS levels was observed in sevelamer group among anuric patients and those using high dose phosphate binders (as figure). However, the changed were not significantly different when compared with calcium carbonate.

Conclusion

Sevelamer may reduce pCS in chronic hemodialysis with minimal RKF, suggesting potential pleiotropic effects. However, long-term follow-up is still required.

Funding

• Commercial Support – Dr.Reddy's Laboratories (Thailand) Co., Ltd.