From the Guidelines
Renvela (Sevelamer) is a phosphate binder used to control high phosphorus levels in patients with chronic kidney disease, particularly those on dialysis, by binding to phosphorus in food and preventing its absorption into the bloodstream. The medication is typically taken with meals, with dosages ranging from 800 to 1600 mg three times daily, depending on phosphorus levels 1. It is available as tablets or powder packets for oral suspension, and patients should take it exactly as prescribed, without crushing or chewing the tablets. Common side effects include digestive issues like nausea, vomiting, and constipation. Renvela is important for kidney patients because high phosphorus levels can lead to bone disease, heart problems, and other complications. Regular blood tests are necessary to monitor phosphorus levels and adjust dosing as needed. Patients should inform their healthcare provider about all other medications they take, as Renvela may interact with certain drugs.
Some key points to consider when using Renvela include:
- The medication should be used in conjunction with dietary phosphate restriction to manage hyperphosphatemia in patients with chronic kidney disease 2.
- Phosphate-lowering therapies, including Renvela, may only be indicated in the event of progressive or persistent hyperphosphatemia, and not for prevention 3.
- The use of calcium-based phosphate binders, such as calcium acetate, may be associated with an increased risk of coronary and aortic calcification, and should be used with caution 4.
- Renvela, as a calcium-free phosphate binder, may be a safer alternative for patients with chronic kidney disease, particularly those with a history of cardiovascular disease 5.
- The dosage of Renvela should be individualized based on the patient's serum phosphate levels, and regular monitoring of phosphorus levels is necessary to adjust dosing as needed 6.
- Patients with significant or symptomatic hypocalcemia may still benefit from correction to prevent adverse consequences, but an individualized approach should be used to treat hypocalcemia rather than recommending correction in all patients 7.
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) 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)
Renvela (Sevelamer) is a phosphate binder indicated for the control of serum phosphorus in patients with chronic kidney disease on dialysis [8] [9].
From the Research
Definition and Mechanism of Renvela (Sevelamer)
- Renvela, also known as Sevelamer, is a phosphate binder used to treat hyperphosphatemia in patients with chronic kidney disease (CKD) 10, 11, 12.
- It works by sequestering phosphate within the gastrointestinal tract, preventing its absorption and enhancing its fecal excretion 11.
- Sevelamer is a non-calcium-based phosphate binder, which means it does not contain calcium or other metals that can be toxic to the body 10, 11.
Benefits and Effects of Sevelamer
- Sevelamer has been shown to lower serum phosphorus levels in CKD patients, reducing the risk of cardiovascular morbidity and mortality 10, 11.
- It also has pleiotropic effects, such as improving serum lipid profiles, attenuating endothelial and cardiovascular risk factors, and reducing the incidence of hypercalcemia and low parathyroid hormone levels 11, 12.
- Sevelamer may be particularly useful for patients at risk of metabolic acidosis, as it offers advantages over other phosphate binders in this regard 12.
Comparison with Other Phosphate Binders
- Sevelamer has been compared to other phosphate binders, such as lanthanum carbonate and calcium-based salts, in terms of efficacy and safety 13, 14.
- While lanthanum carbonate may be more efficacious in lowering serum phosphate concentrations, sevelamer has a more favorable safety profile and may be associated with a survival benefit in some patient populations 11, 14.
- Calcium-based salts are effective but can lead to hypercalcemia and positive calcium balance, which can progress cardiovascular calcification 10, 13.
Formulations and Administration
- Sevelamer is available in several formulations, including sevelamer hydrochloride (Renagel) and sevelamer carbonate (Renvela) 11, 12.
- Sevelamer carbonate is a buffered form of sevelamer hydrochloride and is available as a powder for oral suspension, which may be more patient-friendly than tablet formulations 11, 12.