Effect of reducing calcium load using sevelamer hydrochloride on bone metabolic markers in hemodialysis patients with low parathyroid hormone levels

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  • 副甲状腺ホルモン相対的低値透析症例において塩酸セベラマーを利用したカルシウム負荷軽減が骨代謝マーカーに与える影響
  • フクコウジョウセン ホルモン ソウタイテキ テイチ トウセキ ショウレイ ニ オイテ エンサン セベラマー オ リヨウ シタ カルシウム フカ ケイゲン ガ コツ タイシャ マーカー ニ アタエル エイキョウ

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Sevelamer hydrochloride has been administered to control hyperphosphatemia without calcium load. In this study, we investigated the effects of attenuation of calcium load by sevelamer hydrochloride on bone metabolic markers in 46 hemodialysis patients with serum intact parathyroid hormone (iPTH) levels<150 pg/mL. After replacement of calcium carbonate with sevelamer, their serum calcium levels decreased. The iPTH levels increased after 4 weeks and the magnitude of the increase was highly correlated with the extent of decrease in serum calcium concentration. Whole PTH, bone alkaline phosphatase (BAP), and bone-specific tartrate-resistant acid phosphatase (TRAP5b) levels were also increased after 12 weeks. However, the relationship between iPTH and BAP or TRAP5b that was observed before the sevelamer replacement therapy was preserved only in patients with serum iPTH levels<60 pg/mL at enrollment. Thus, in patients with pretreatment iPTH levels ≥ 60 and<150 pg/mL, the increase in iPTH level might not always result in the improvement of bone metabolism. In the patients administered vitamin D at enrollment, the frequency of overshooting iPTH, BAP, or TRAP5b levels was lower than that in the patients without vitamin D administration. In conclusion, replacing calcium carbonate with sevelamer could be a therapeutic option to improve bone metabolism in patients with hypoparathyroidism (iPTH<60 pg/mL) and vitamin D might be useful to avoid the excess enhancement of bone turnover by sevelamer therapy.

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