Authors' recommendations: The published literature shows that sevelamer appears to as effective as calcium-based phosphate binders in the management of hyperphosphatemia in dialysis patients without elevating serum calcium levels, although the phosphate levels in sevelamer treated patients were slightly higher than those receiving calcium based agents. Elevation of serum calcium is believed to be associated with vascular calcification. The systematic review and RCT results suggest that sevelamer may slow down the progression of vascular calcification although its impact on total mortality or cardiovascular mortality has not clinically been proven. From the included RCTs, the apparent benefits of sevelamer are its lipid lowering effect, particularly total cholesterol and LDL cholesterol, and its uric acid lowering effect. Two trials raised concern that sevelamer may worsen metabolic acidosis that may be an important risk factor for bone metabolism and the prognosis of dialysis patients. Taken together, there is no evidence in the published literature that sevelamer improves morbidity and mortality in dialysis patients. The inconsistent data are a consideration and the routine use of sevelamer in dialysis patients does not appear to be supported by the current literature.

Project Status: Completed

URL for project: http://www.cadth.ca/media/pdf/L0120_Sevelamer_for_Chronic_Kidney_Sisease_final.pdf

Year Published: 2009

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)