The effects of sevelamer hydrochloride on metabolic acidosis in hemodialysis patients with citrate dialysate

Matsushita Kazumichi, Tabata Hidehiro, Nitta Kosaku, Tago Kiichiro

doi:10.4009/jsdt.43.373

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Other Title

塩酸セベラマー内服量が血液透析患者の酸塩基平衡に及ぼす影響―クエン酸透析液使用でも，代謝性アシドーシスを悪化させるか？―
エンサンセベラマーナイフクリョウガケツエキトウセキカンジャノサンエンキヘイコウニオヨボスエイキョウクエンサントウセキエキシヨウデモタイシャセイアシドーシスオアッカサセルカ
―クエン酸透析液使用でも，代謝性アシドーシスを悪化させるか？―

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Description

Metabolic acidosis has been independently associated with increased risk of hospitalization and decreased life-expectancy in dialysis patients. The use of sevelamer hydrochloride (SH) with acetate dialysate has reportedly reduced plasma bicarbonate (HCO₃) levels. To investigate whether metabolic acidosis can be improved when SH is used with citrate dialysate, cross sectional studies were performed. In study 1,183 patients on hemodialysis in our clinic were divided into four groups ; group C : calcium carbonate was used, group C+S : calcium carbonate was used with SH, group S : SH was used, group N : no phosphate binder (P-binder). Then the relationship between P-binders and each parameter of metabolic acidosis was examined. Study 2 examined the relationship between daily SH use and each parameter of metabolic acidosis. Study 1 showed that the plasma HCO₃ level in group C and N satisfied the K/DOQI guidelines (≥22 mmol/L), but the levels (mean±SE) in group C+S (20.6±2.9 : p=0.003) and S (21.2±3.2 : p=0.02) decreased and were below the guidelines. The plasma level of potassium (K), chloride (Cl) and the anion-gap (AG) were significantly increased in group C+S (p<0.0001) and group S (p<0.0001), group S (p=0.028) and group C+S (p=0.023), respectively. Study 2 showed that daily SH use negatively correlated with pH (p=0.0004), HCO₃ (p<0.0001) and base excess (p<0.0001), and positively correlated with K (p<0.0001), Cl (p=0.0003) and AG (p=0.01). Increased daily SH use worsened metabolic acidosis despite the use of citrate dialysate. It is cautiously suggested that SH treatment of hyperphosphatemia causes acid loading. We look forward to the development of other P-binders that do not have negative effects on plasma HCO₃ levels.

Journal

Nihon Toseki Igakkai Zasshi

Nihon Toseki Igakkai Zasshi 43 (4), 373-379, 2010

The Japanese Society for Dialysis Therapy

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