Meta-analysis of the effect of sevelamer on phosphorus, calcium, PTH, and serum lipids in dialysis patients

Abstract Hyperphosphatemia and dyslipidemia are common clinically significant conditions in end-stage renal disease (ESRD). Hyperphosphatemia management is essential; however, use of calcium-based phosphate binder has been associated with elevated risk of cardiac calcification in ESRD, increasing risks for cardiovascular disease and death. An alternative to calcium-based phosphate binders is sevelamer hydrochloride, a calcium-free, metal-free, nonabsorbed polymer that binds phosphate effectively. We conducted a meta-analysis on the effects of sevelamer hydrochloride on parameters of mineral metabolism (serum phosphorous, calcium, Ca × P, and iPTH) and the lipid profile (total, LDL, HDL, and non-HDL cholesterol, and triglycerides) in dialysis patients. After application of inclusion/exclusion criteria, 17 core studies were statistically analyzed to determine the sevelamer treatment effect on the study parameters as demonstrated by simple, n-weighted, and inverse variance-weighted mean changes. Analysis of inverse variance-weighted mean changes indicated that sevelamer treatment was associated with a 2.14 mg/dL drop in serum phosphorus ( P P = .364), significant decline in Ca × P product (15.91 mg 2 /dL 2 , P P = .026), significant reduction in total cholesterol (30.58 mg/dL, P P P = .008), and a significant reduction in triglycerides (22.04 mg/dL, P × .001). This meta-analysis suggests that sevelamer offers a dual therapeutic benefit in dialysis patients—a population at high risk for cardiovascular disease—by improving phosphorus control and the lipid profile, without altering serum calcium. © 2003 by the National Kidney Foundation, Inc.