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document
Phosphate binder impact on bone remodeling and coronary calcification -- results from the BRiC study . BACKGROUND AND AIMS Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients . This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification ( CAC ) and bone histology . METHODS 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months . RESULTS The 71 patients who concluded the study had similar baseline characteristics . On follow-up , the sevelamer group had higher levels of intact parathyroid hormone ( 498 +/- 352 vs. 326 +/- 236 pg/ml , p = 0.017 ) , bone alkaline phosphatase ( 38 +/- 24 vs. 28 +/- 15 U/l , p = 0.03 ) and deoxypyridinoline ( 135 +/- 107 vs. 89 +/- 71 nmol/l , p = 0.03 ) and lower LDL cholesterol ( 74 +/- 21 vs. 91 +/- 28 mg/dl , p = 0.015 ) . Phosphorus ( 5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl , p = 0.47 ) and calcium ( 1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l , p = 0.68 ) levels did not differ between groups . CAC progression ( 35 vs. 24 % , p = 0.94 ) and bone histological diagnosis at baseline and 12 months were similar in both groups . Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption ( eroded surface , ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5 % , p = 0.05 ) , whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate ( BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078 , p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 microm ( 3 ) /microm ( 2 ) /day , p = 0.010 for sevelamer ) . CONCLUSIONS There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups .
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Intervention_Pharmacological
Phosphate binder
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Intervention_Pharmacological
Calcium-containing phosphate binders
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Intervention_Pharmacological
calcium acetate and sevelamer
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Intervention_Pharmacological
phosphate binder
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Intervention_Pharmacological
multislice coronary tomographies and bone biopsies
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Outcome_Physical
bone remodeling
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Outcome_Physical
coronary calcification
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Outcome_Physical
vascular calcification
37927
Outcome_Physical
coronary calcification
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Outcome_Physical
bone histology
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Outcome_Physical
intact parathyroid hormone
37930
Outcome_Physical
bone alkaline phosphatase
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Outcome_Physical
deoxypyridinoline
37932
Outcome_Physical
LDL cholesterol
37933
Outcome_Physical
Phosphorus
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Outcome_Physical
calcium
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Outcome_Physical
CAC progression
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Outcome_Physical
bone histological diagnosis
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Outcome_Physical
bone resorption
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Outcome_Physical
bone formation rate
37939
Outcome_Physical
CAC progression
37940
Outcome_Physical
bone remodeling
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Participant_Condition
hemodialysis
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Participant_Sample-size
101
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Participant_Condition
hemodialysis
37944
Participant_Sample-size
71