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Impact of Sevelamer Hydrochloride and the K/DOQI Guidelines
Author(s) -
Yumita Shigeru
Publication year - 2005
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2005.00280.x
Subject(s) - medicine , sevelamer , renal osteodystrophy , urology , phosphate binder , parathyroid hormone , calcitriol , vitamin d and neurology , kidney disease , hemodialysis , secondary hyperparathyroidism , calcium , hyperparathyroidism , gastroenterology , endocrinology , hyperphosphatemia
Sevelamer hydrochloride (SH) was registered as a new drug under the Japanese national health insurance scheme in 2003, and the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for the treatment of renal osteodystrophy were released the same year. At that time, treatment objectives for hemodialysis outpatients at the Kojinkai Ishimaki Clinic were settled established and the outcomes reviewed 18 months later. The relationship between the type and dosage of phosphate binder (PB), and the concentrations of adjusted calcium (Ca), phosphorus (P), intact parathyroid hormone (PTH), and bone alkaline phosphatase (BAP) was examined. Patients receiving calcitriol or maxacalcitol intravenous pulse therapy, or who had undergone simultaneous pancreas–kidney transplant, were excluded from this analysis. The PB was CaCO 3 in 60% of cases, SH in 33.3%, and a combination of both in 21.9%; no PB was used in 6.7% of cases. The dosage of CaCO 3 was 2.8 ± 1.0 g/day, and 1α‐hydroxy activated vitamin D 3 (VD) was 0.46 ± 0.24 µg/day; the respective concentrations of adjusted Ca, P, intact PTH, and BAP were 9.4 ± 0.7 mg/dL, 5.6 ± 1.7 mg/dL, 104 ± 83.9 pg/mL, and 22.7 ± 10.9 IU/L. In the SH monotherapy group, the dosage of SH was 3.9 ± 0.725 g/day, and VD 0.62 ± 0.21 µg/day, and the concentrations for adjusted Ca, P, intact PTH, and BAP were 9.6 ± 0.4 mg/dL, 6.2 ± 1.5 mg/dL, 150 ± 42.9 pg/mL, and 38.5 ± 14.2 IU/L, respectively. In the combined therapy group, the dosage of CaCO 3 was 2.9 ± 0.9 g/day, SH was 3.3 ± 1.1 g/day, VD was 0.53 ± 0.27 µg/day, and the respective concentrations were 9.2 ± 1.0 mg/dL, 5.7 ± 1.4 mg/dL, 160 ± 107.8 pg/mL, and 31.3 ± 42.0 IU/L. One‐third of all subjects were administered SH, either as monotherapy or in combination with CaCO 3 , and in these patients the dosage of VD was able to increase.