1. ¹Renal Section, Department of Medicine, The Kidney Institute and Baylor College of Medicine, Houston, Texas, USA
2. ²Northwest Louisiana Nephrology, Shreveport, Louisiana, USA
3. ³Jose Cangiano Nephrology, San Juan, Puerto Rico, USA
4. ⁴Nephrology Associates, Columbus, Mississippi, USA
5. ⁵Kidney and Hypertension Center, Cincinnati, Ohio, USA
6. ⁶Wake Nephrology, Raleigh, North Carolina, USA
7. ⁷Mountain Kidney Associates, Asheville, North Carolina, USA
8. ⁸Genzyme Corporation, Cambridge, Massachusetts, USA

Correspondence: WN Suki, The Kidney Institute, Baylor College of Medicine, 1415 La Concha Lane, Houston, Texas 77054, USA. E-mail: wsuki@bcm.tmc.edu

Deceased.

Received 13 February 2007; Revised 30 May 2007; Accepted 12 June 2007; Published online 29 August 2007.

Abstract

Elevated serum phosphorus and calcium are associated with arterial calcification and mortality in dialysis patients. Unlike calcium-based binders, sevelamer attenuates arterial calcification but it is unknown whether sevelamer affects mortality or morbidity. In a multicenter, randomized, open-label, parallel design trial we compared sevelamer and calcium-based binders on all-cause and cause-specific mortality (cardiovascular, infection, and other) in prevalent hemodialysis patients. A total of 2103 patients were initially randomized to treatment and 1068 patients completed the study. All-cause mortality rates and cause-specific mortality rates were not significantly different. There was a significant age interaction on the treatment effect. Only in patients over 65 years of age was there a significant effect of sevelamer in lowering the mortality rate. There was a suggestion that sevelamer was associated with lower overall, but not cardiovascular-linked, mortality in older patients. We suggest that further research is needed to confirm these findings.