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Li Yang, Seng Chuen Tan, Can Chen, Xingzhi Wang, Xinya Li, Xiaoyan Yang
PURPOSE: To conduct a cost-effectiveness analysis study of sevelamer versus calcium-based binders (CBBs) in treating hyperphosphatemia among patients with end-stage renal disease (ESRD) in China. METHODS: A decision-analytic model of a lifetime horizon was used for base case analysis from the payers' perspective. The transition probabilities between different health states were derived from survival analysis. The overall survival of CBBs was derived from the Dialysis Clinical Outcomes Revisited study for up to 44 months and a Weibull regression model was used to extrapolate the overall survival to a lifetime horizon...
October 14, 2016: Clinical Therapeutics
Steven Habbous, Sebastian Przech, Rey Acedillo, Sisira Sarma, Amit X Garg, Janet Martin
BACKGROUND: It remains unclear which phosphate binders should be preferred for hyperphosphatemia management in chronic kidney disease (CKD). METHODS: We performed a systematic review and meta-analysis of randomized trials comparing sevelamer or lanthanum with other phosphate binders in CKD. RESULTS: Fifty-one trials (8829 patients) were reviewed. Compared with calcium-based binders, all-cause mortality was nonsignificantly lower with sevelamer {risk ratio [RR] 0...
September 20, 2016: Nephrology, Dialysis, Transplantation
Diana Jalal, Molly McFadden, Jamie P Dwyer, Kausik Umanath, Erwin Aguilar, Yoram Yagil, Barbara Greco, Mohammed Sika, Julia B Lewis, Tom Greene, Simin Goral
Introduction Oral phosphate binders are the main stay of treatment of hyperphosphatemia. Adherence rates to ferric citrate, a recently approved phosphate binder, are unknown. Methods We conducted a post-hoc analysis to evaluate whether adherence rates were different for ferric citrate vs. active control in 412 subjects with end stage kidney disease (ESKD) who were randomized to ferric citrate vs. active control (sevelamer carbonate and/or calcium acetate). Adherence was defined as percent of actual number of pills taken to total number of pills prescribed...
September 12, 2016: Hemodialysis International
Brett M McGettigan, Rachel H McMahan, Yuhuan Luo, Xiaoxin X Wang, David J Orlicky, Cara Porsche, Moshe Levi, Hugo R Rosen
Bile acid sequestrants are synthetic polymers that bind bile acids in the gut and are used to treat dyslipidemia and hyperphosphatemia. Recently, these agents have been reported to lower blood glucose and increase insulin sensitivity by altering bile acid signaling pathways. In this study, we assessed the efficacy of sevelamer in treating mice with non-alcoholic fatty liver disease (NAFLD). We also analyzed how sevelamer alters inflammation and bile acid signaling in NAFLD livers. Mice were fed a low-fat or Western diet for 12 weeks followed by a diet-plus-sevelamer regimen for 2 or 12 weeks...
October 28, 2016: Journal of Biological Chemistry
Maurizio Bossola, Enrico Di Stasio, Maurizio Sanguinetti, Brunella Posteraro, Manuela Antocicco, Gilda Pepe, Enrica Mello, Francesca Bugli, Carlo Vulpio
BACKGROUND: This study aims to evaluate, in patients on chronic hemodialysis (PHD), the levels of endotoxin through a chemiluminescent bioassay based on the oxidative burst reaction of activated neutrophils to complement coated LPS-IgM immune complexes and define the variables possibly correlated. METHODS: In 61 PHD, we measured serum endotoxin activity (EA) with the Endotoxin Activity Assay (EAA™) and we defined the possible association with demographic, clinical and laboratory variables...
August 31, 2016: Blood Purification
Takahisa Yamaguchi, Shigekazu Ohyama, Hiroyuki Furukawa, Nariatsu Sato, Ichiro Ohnishi, Satomi Kasashima, Atsuhiro Kawashima, Masato Kayahara
INTRODUCTION: Sevelamer is an anion exchange resin used to treat hyperphosphatemia. A common adverse effect of sevelamer is constipation. According to a review of the available literature, colon perforation associated with this resin agent was less common. PRESENTATION OF CASE: A 66-year-old man complaining of lower abdominal pain was transferred to our hospital. The patient had been undergoing hemodialysis for chronic renal failure due to rapidly progressive glomerulonephritis, and had been receiving sevelamer hydrochloride 4...
September 2016: Annals of Medicine and Surgery
Mario Cozzolino, Michela Mangano, Lorenza Magagnoli, Luca Di Lullo, Andrea Galassi, Diego Brancaccio, Antonio Bellasi
Several factors influence the choice of phosphate binder for patients, including older age, male gender, post-menopause, diabetes, low bone turnover, vascular/valvular calcification and inflammation. Unlike calcium-based phosphate binders, non-calcium-based phosphate binders, such as sevelamer and lanthanum carbonate, have been able to reduce the progression of bone disease to adynamic bone among patients with CKD. New iron-based phosphate binders are now available. With multiple options available for the reduction of phosphate, the focus has been on agents that do not contain calcium...
July 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Fumihiko Koiwa, Keitaro Yokoyama, Masafumi Fukagawa, Akira Terao, Tadao Akizawa
AIM: We aimed to investigate the non-inferiority of PA21 (sucroferric oxyhydroxide) to sevelamer hydrochloride (sevelamer) in terms of efficacy and safety in Japanese haemodialysis patients with hyperphosphataemia. METHODS: In this Phase III, open-label, multicentre study, 213 haemodialysis patients with hyperphosphataemia were randomised to PA21 or sevelamer treatment for 12 weeks. The primary outcome was adjusted serum phosphorus concentration at the end of treatment; the non-inferiority of PA21 was confirmed if the upper limit of the two-sided 95% confidence interval (CI) is ≤0...
August 6, 2016: Nephrology
Shroque Zaher, Ahsan Ali, Paul Babu
No abstract text is available yet for this article.
August 3, 2016: Thorax
Suetonia C Palmer, Sharon Gardner, Marcello Tonelli, Dimitris Mavridis, David W Johnson, Jonathan C Craig, Richard French, Marinella Ruospo, Giovanni F M Strippoli
BACKGROUND: Guidelines preferentially recommend noncalcium phosphate binders in adults with chronic kidney disease (CKD). We compare and rank phosphate-binder strategies for CKD. STUDY DESIGN: Network meta-analysis. SETTING & POPULATION: Adults with CKD. SELECTION CRITERIA FOR STUDIES: Randomized trials with allocation to phosphate binders. INTERVENTIONS: Sevelamer, lanthanum, iron, calcium, colestilan, bixalomer, nicotinic acid, and magnesium...
July 22, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Ellen Neven, Britt Opdebeeck, Annelies De Maré, Rida Bashir-Dar, Geert Dams, Rita Marynissen, Geert J Behets, Anja Verhulst, Bruce L Riser, Patrick C D'Haese
Vascular calcification significantly contributes to mortality in chronic kidney disease (CKD) patients. Sevelamer and pyrophosphate (PPi) have proven to be effective in preventing vascular calcification, the former by controlling intestinal phosphate absorption, the latter by directly interfering with the hydroxyapatite crystal formation. Since most patients present with established vascular calcification, it is important to evaluate whether these compounds may also halt or reverse the progression of preexisting vascular calcification...
November 2016: Calcified Tissue International
Antonio Bellasi, Mario Cozzolino, Domenico Russo, Donald Molony, Biagio Di Iorio
AIMS: Whether differences in outcomes of calcium-free vs. calcium-containing phosphate binder treatments can be amplified by concurrent treatment with a calcium-sensing receptor agonist or vitamin D remains to be elucidated. MATERIAL AND METHODS: A post-hoc analysis of the INDEPENDENT study, an open-label randomized controlled trial designed to evaluate the impact of sevelamer (SV) vs. calcium salts (CS) on survival in incident dialysis patients. RESULTS: We recruited 466 middle-aged men and women...
September 2016: Clinical Nephrology
Aaltje Y Adema, Maarten A de Jong, Martin H de Borst, Pieter M Ter Wee, Marc G Vervloet
BACKGROUND: Increased levels of phosphate and fibroblast growth factor-23 (FGF23) are strong predictors of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). Preliminary data suggest that interventions lowering gastro-intestinal phosphate uptake lowers serum FGF23 concentrations and improves cardiovascular risk and subsequently survival. However, data are lacking about the magnitude of effects, the effect in different stages of CKD and whether there is a dose-effect relationship...
July 22, 2016: Nephron
Stuart M Sprague, Adrian C Covic, Jürgen Floege, Markus Ketteler, Jaco Botha, Edward M Chong, Anjay Rastogi
BACKGROUND: Many patients with chronic kidney disease are prescribed vitamin D receptor agonists (VDRAs) for the management of secondary hyperparathyroidism. Oral phosphate binders may interact with, and potentially reduce the therapeutic activity of, oral VDRAs. 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. METHODS: One thousand and fifty nine patients were randomized to SFOH 1...
2016: American Journal of Nephrology
Maria Julia C L N Araujo, Cristina Karohl, Rosilene M Elias, Fellype C Barreto, Daniela Veit Barreto, Maria Eugenia F Canziani, Aluizio B Carvalho, Vanda Jorgetti, Rosa M A Moyses
Although it is recognized that cortical bone contributes significantly to the mechanical strength of the skeleton, little is known about this compartment from bone biopsy studies, particularly in CKD patients. In addition, there is no prospective data on the effects of CKD-MBD therapy on cortical porosity (Ct.Po). This is a post hoc analysis on data from a randomized controlled trial on the effects of different phosphate binders on bone remodelling. Therapy was adjusted according to the first biopsy, and included sevelamer or calcium acetate, calcitriol and changes in calcium dialysate concentration...
October 2016: Bone
Rana Rizk
Hyperphosphatemia management is integral to the management of patients with chronic kidney disease. This mineral abnormality is associated with greater costs, but so is its management, especially with the use novel phosphate binders. The economic evaluation of these pharmaceutical agents is increasingly needed to provide evidence for value of money spent and inform resource allocation. Recently, Nguyen et al. explored the economical attractiveness of Sevelamer relative to Calcium Carbonate among patients with chronic kidney disease not yet on dialysis and concluded that the former was cost-effective...
2016: BMC Nephrology
Adrian C Covic, Jürgen Floege, Markus Ketteler, Stuart M Sprague, Laura Lisk, Viatcheslav Rakov, Anjay Rastogi
BACKGROUND: Sucroferric oxyhydroxide is a non-calcium, iron-based phosphate binder indicated for the treatment of hyperphosphataemia in adult dialysis patients. This post hoc analysis of a randomized, 24-week Phase 3 study and its 28-week extension was performed to evaluate the long-term effect of sucroferric oxyhydroxide on iron parameters. METHODS: A total of 1059 patients were randomized to sucroferric oxyhydroxide 1.0-3.0 g/day (n = 710) or sevelamer carbonate ('sevelamer') 2...
June 23, 2016: Nephrology, Dialysis, Transplantation
Khalidur Rahman, Chirayu Desai, Smita S Iyer, Natalie E Thorn, Pradeep Kumar, Yunshan Liu, Tekla Smith, Andrew S Neish, Hongliang Li, Shiyun Tan, Pengbo Wu, Xiaoxiong Liu, Yuanjie Yu, Alton B Farris, Asma Nusrat, Charles A Parkos, Frank A Anania
BACKGROUND & AIMS: There is evidence from clinical studies that compromised intestinal epithelial permeability contributes to the development of nonalcoholic steatohepatitis (NASH), but the exact mechanisms are not clear. Mice with disruption of the gene (F11r) encoding junctional adhesion molecule A (JAM-A) have defects in intestinal epithelial permeability. We used these mice to study how disruption of the intestinal epithelial barrier contributes to NASH. METHODS: Male C57BL/6 (control) or F11r(-/-) mice were fed a normal diet or a diet high in saturated fat, fructose, and cholesterol (HFCD) for 8 weeks...
October 2016: Gastroenterology
Ross Robison, Danielle Cooney, Mary Beth Low, Niraj Desai
BACKGROUND: Hyperphosphatemia is a common problem in patients with chronic kidney disease (CKD). Calcium-containing phosphate binders are typically used as first-line therapy, primarily due to cost considerations. Non-calcium phosphate binders such as sevelamer and lanthanum may be considered in the appropriate setting. It is hypothesized that lanthanum is less costly and has a lower pill burden compared to sevelamer carbonate. OBJECTIVE: Determine the difference in cost (outcome 1) and tablet burden (outcome 2) between sevelamer carbonate and lanthanum within the Veteran population...
April 2016: Hospital Pharmacy
Nigar Sekercioglu, Lehana Thabane, Juan Pablo Díaz Martínez, Gihad Nesrallah, Christopher J Longo, Jason W Busse, Noori Akhtar-Danesh, Arnav Agarwal, Reem Al-Khalifah, Alfonso Iorio, Gordon H Guyatt
BACKGROUND: Chronic kidney disease-mineral and bone disorder (CKD-MBD) has been linked to poor health outcomes, including diminished quality and length of life. This condition is characterized by high phosphate levels and requires phosphate-lowering agents-phosphate binders. The objective of this systematic review is to compare the effects of available phosphate binders on patient-important outcomes in patients with CKD-MBD. METHODS: Data sources included MEDLINE and EMBASE Trials from 1996 to February 2016...
2016: PloS One
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