From the Guidelines
Sevelamer hydrochloride (Renagel) is an effective phosphate binder used to treat hyperphosphatemia in chronic kidney disease patients, with a typical starting dose of 800-1600 mg three times daily with meals, which can be titrated up to 2400 mg three times daily based on serum phosphate levels 1.
Key Considerations
- The medication works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption and facilitating its elimination through feces.
- For optimal effectiveness, sevelamer should be taken with meals as it specifically targets phosphate from food.
- Regular monitoring of serum phosphate levels is essential, with a target range of 3.5-5.5 mg/dL.
- Unlike calcium-based phosphate binders, sevelamer doesn't contribute to calcium load, making it particularly valuable for patients with hypercalcemia or vascular calcification concerns.
Important Recommendations
- Decisions about phosphate-lowering treatment should be based on progressively or persistently elevated serum phosphate levels 1.
- Phosphate-lowering therapies may only be indicated in the event of progressive or persistent hyperphosphatemia and not for prevention.
- Limiting dietary phosphate intake is recommended in the treatment of hyperphosphatemia alone or in combination with other treatments 1.
Side Effects and Precautions
- Common side effects include gastrointestinal disturbances such as constipation, nausea, and bloating.
- Patients should maintain adequate fluid intake to minimize constipation risk.
- Dietary phosphate restriction (800-1000 mg/day) should accompany medication therapy for comprehensive management of hyperphosphatemia in CKD.
From the FDA Drug Label
INDICATIONS AND USAGE • Sevelamer hydrochloride tablets are a phosphate binder indicated for the control of serum phosphorus in patients with chronic kidney disease on dialysis. (1) The treatment for hyperphosphatemia in patients with chronic kidney disease using Sevelamer (sevelamer hydrochloride) is to use sevelamer hydrochloride as a phosphate binder to control serum phosphorus levels 2.
- Key points:
From the Research
Treatment for Hyperphosphatemia in Patients with Chronic Kidney Disease using Sevelamer
- Sevelamer hydrochloride is a metal-free cationic hydrogel polymer/resin that binds dietary phosphate in the gastrointestinal tract, approved for use in treating hyperphosphatemia in adult patients with end-stage renal disease (ESRD) on haemodialysis or peritoneal dialysis 3.
- Sevelamer carbonate is an improved, buffered form of sevelamer hydrochloride, developed for the treatment of hyperphosphatemia in patients with chronic kidney disease, and has been shown to be effective in controlling serum phosphorus levels in hyperphosphatemic patients who are not on dialysis 4.
- Clinical evidence suggests that sevelamer is at least as effective as calcium acetate and calcium carbonate at controlling serum phosphorus, calcium-phosphorus product, and intact parathyroid hormone levels, but generally reduces serum calcium levels to a greater extent and is associated with a lower risk of hypercalcaemic episodes than calcium-based phosphate binders 3.
- Sevelamer has been shown to slow the progression of cardiovascular calcification in patients with ESRD and has a beneficial effect on serum low-density lipoprotein-cholesterol levels 3.
Comparison with Other Phosphate Binders
- Lanthanum carbonate has been shown to be more efficacious in lowering serum phosphate concentrations and effectively managing hyperphosphatemia compared to sevelamer carbonate 5.
- A cost-effectiveness analysis comparing sevelamer and lanthanum with calcium-based binders for patients with CKD found that sevelamer may be cost-effective before dialysis onset, but the evidence does not clearly support the cost-effectiveness of non-calcium-containing phosphate binders in dialysis-dependent CKD patients 6.