• Yasunori Iwata, Takashi Wada, Hitoshi Yokoyama, Tadashi Toyama, Shinji Kitajima, Toshiya Okumura, Akinori Hara, Junya Yamahana, Izaya Nakaya, Motoo Kobayashi, Kiyoki Kitagawa, Satoshi Kokubo, Keiichi Yoshimoto, Kazuaki Shimizu, Norihiko Sakai, Kengo Furuichi, Yoshitaka Koshino, Shinichi Takeda, Kazuya Takasawa, Satoshi Ohta, Masayoshi Takaeda, Chikako Takaeda, and Shuichi Kaneko.
• Disease Control and Homeostasis, Kanazawa University Graduate School of Medicine. iwata-knz@umin.ac.jp
• Intern. Med. 2007 Jan 1; 46 (8): 447452447-52.

BackgroundIn hemodialysis patients, adynamic bone disease has been reported to be closely associated with low levels of parathyroid hormone (PTH) due to exposure to high levels of serum calcium following the administration of calcium carbonate (CaCO3) or vitamin D agents. This study was conducted to clarify the therapeutic effect of a non-calcemic phosphate binder, sevelamer hydrochloride (sevelamer), for hypoparathyroidism in hemodialysis patients with or without diabetes mellitus.MethodsBased on entry criteria, 40 Japanese chronic hemodialysis patients (22 males and 18 females with a mean age of 60.6, 14 diabetic patients and 26 non-diabetic patients) were switched from CaCO3 to sevelamer for 48 weeks. Serum calcium, phosphate, intact (i) PTH and PTH-(1-84) were analyzed. Bone remodeling activity was evaluated by determining intact osteocalcine (iOC), bone-specific alkaline phosphatase (BAP).ResultsThe switch from CaCO3 to sevelamer significantly decreased the serum levels of calcium, resulting in the elevation of iPTH levels from 31+/-18 pg/mL to 95+/-96 pg/mL by 48 weeks. In contrast, serum phosphate levels remained similar to those in patients with CaCO3 treatment. Concomitantly, the levels of BAP and iOC were elevated. Further, these beneficial effects on bone turnover were observed in both diabetic and non-diabetic patients.ConclusionSevelamer reduced the calcium concentration and thereby increased PTH levels, resulting in the improvement of markers of bone turnover. The administration of sevelamer is of therapeutic benefit for the improvement of bone remodeling activity even in hemodialysis patients with diabetes.

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