{"id":"35f57a895590","type":"article","url":"https://hartvaat.nl/2026/11/01/sevelamer-remt-vaatstijfheid-sterker-dan-calciumcarbonaat-bij-dialysepatienten-m/","title":"Sevelamer remt vaatstijfheid sterker dan calciumcarbonaat bij dialysepatiënten — multicenter RCT","title_en":"Protein-bound Uremic Toxin Lowering Effects of Sevelamer in Hyperphosphatemic Hemodialysis Patients: A Multicenter Randomized Controlled Trial.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Kidney medicine","doi":"10.1016/j.xkme.2026.101527","source_url":"https://doi.org/10.1016/j.xkme.2026.101527","authors":["Napas Srifa","Jeerath Phannajit","Patchara Tanateerapong","Kamonrat Chongthanakorn","Sipanan Thamratnopkoon","Wannasit Wathanavasin","Supat Vanichakarn","Sookruethai Lekhyananda","Yingyos Avihingsanon","Kearkiat Praditpornsilpa","Somchai Eiam-Ong","Paweena Susantitaphong"],"significance":5,"published":"2026-11-08","source_date":"2026-11-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"In a multicenter RCT involving hemodialysis patients with hyperphosphatemia, sevelamer was compared with calcium carbonate as a phosphate binder over 24 weeks. While both agents effectively lowered phosphate levels, sevelamer did not significantly reduce protein-bound uremic toxin p-cresyl sulfate compared with calcium carbonate. However, sevelamer was associated with a smaller increase in the cardio-ankle vascular index (CAVI), a marker of arterial stiffness (P = 0.04). Given the study's limitations regarding sample size and surrogate endpoints, these findings suggest a potential vascular benefit of sevelamer but require confirmation in larger, longer-term trials.","created":"2026-11-01T02:45:19Z","updated":"2026-11-01T02:45:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een multicenter RCT bij dialysepatiënten met hyperfosfatemie werd de effectiviteit van sevelamer vergeleken met calciumcarbonaat als fosfaatbinder over 24 weken. Hoewel beide middelen de fosfaatspiegels verlaagden, leidde sevelamer niet tot een significante daling van de eiwitgebonden uremetoxine p-cresylsulfaat (pCS). Wel werd een minder sterke toename van de cardio-ankle vasculaire index (CAVI) waargenomen bij sevelamer (P = 0,04), wat wijst op een mogelijk gunstig effect op vaatstijfheid. De bevindingen zijn preliminair vanwege de beperkte steekproefgrootte en het gebruik van surrogaatmarkeringen, maar ondersteunen het gebruik van sevelamer bij dialysepatiënten met cardiovasculaire risicofactoren.","abstract_original":"RATIONALE & OBJECTIVE: p-Cresyl sulfate (pCS) is an important protein-bound uremic toxin associated with high cardiovascular mortality in patients receiving long-term hemodialysis (HD). Data regarding pCS lowering and the pleiotropic effects of sevelamer are limited in patients receiving long-term HD. STUDY DESIGN: Open-label, multicenter randomized controlled trial. SETTING & PARTICIPANTS: Patients with hyperphosphatemia receiving long-term HD. EXPOSURES: Patients were randomly assigned to receive either sevelamer or calcium carbonate as phosphate binders for 24 weeks. OUTCOMES: The primary outcome was the between-group difference in pCS change over 24 weeks. Secondary outcomes included changes in high-sensitivity C-reactive protein levels, intact parathyroid hormone levels, cardio-ankle vascular index, and adverse event rates. ANALYTICAL APPROACH: Mean differences between groups were analyzed using a linear mixed model. Multivariate logistic regression was used to determine factors associated with decreased pCS levels. RESULTS: A total of 128 patients were enrolled, 4 dropped out, and 124 were analyzed. Residual kidney function (RKF) ≥100 mL/day was present in 47.7%. Both groups achieved significant phosphate reduction. Mean changes in pCS did not differ significantly between groups: 0.70 mg/L (95% CI, -1.04 to 2.44) in the sevelamer group versus -0.09 mg/L (95% CI, -1.70 to 1.51) in the calcium carbonate group (P = 0.07). However, sevelamer was associated with a smaller increase in cardio-ankle vascular index than calcium carbonate (adjusted mean change difference -0.63 [95% CI, -1.22 to -0.04]; P = 0.04). Preserved RKF and high-dose phosphate binders were independently associated with decreased pCS levels. LIMITATIONS: Change in pCS is only a surrogate marker for cardiovascular events. The study may have been underpowered, or the sevelamer dose and treatment duration may have been insufficient. CONCLUSIONS: pCS levels were not significantly changed in both groups. However, the increase in cardio-ankle vascular index was smaller with sevelamer than with calcium carbonate, independent of pCS change. Further trials with larger samples and longer treatment durations are warranted."}