Pieper A-K et al. (2006) A randomized crossover trial comparing sevelamer with calcium acetate in children with CKD. Am J Kidney Dis 47: 625–635

Calcium-containing phosphate binders are the current mainstay of treatment for hyperphosphatemia in children with chronic kidney disease (CKD), but they are associated with an increased risk of vascular calcification. Now, researchers in Germany have found that sevelamer, a calcium-free phosphate binder that has been used widely in the adult hemodialysis population, might also be suitable for treating hyperphosphatemia in the pediatric setting.

In this multicenter, open-label, crossover study, 18 pediatric dialysis patients (mean age 12.4 years) were randomized to receive calcium acetate or sevelamer. After 8 weeks, both treatments significantly reduced serum phosphorus levels, by similar amounts (both P <0.005 compared with baseline). In sevelamer-treated patients, there was a 27% reduction in mean total cholesterol levels and a 34% decrease in mean LDL cholesterol levels after 8 weeks (P <0.05 for both), but these parameters did not change in the calcium-acetate-treated patients. The incidence of hypercalcemia (serum calcium levels >2.8 mmol/l) was significantly greater after 8 weeks of calcium acetate treatment (P <0.0001), whereas sevelamer therapy increased the incidence of metabolic acidosis (P <0.005). No other serious adverse events were significantly associated with either treatment, and compliance with treatment was generally good in both groups.

Subject to confirmation in larger trials, sevelamer might become the treatment of choice for children with CKD plus hyperphosphatemia, because of its additional cholesterol-lowering benefits. Sevelamer-treated patients should, however, be closely monitored for metabolic acidosis.