Abstract 9529: Effects of Sevelamer Carbonate on Arterial Stiffness and Left Ventricular Mass in Patients with Stage 3 Chronic Kidney Disease: Results of a Randomized Controlled Trial

Abstract

Introduction: Serum phosphate independently predicts cardiovascular mortality in the general population and in chronic kidney disease (CKD), even when levels are in the normal range. Phosphate has been implicated in the development and progression of vascular calcification and increased arterial stiffness, which is a driver of structural heart disease. We hypothesised that the non-calcium-based phosphate binder sevelamer carbonate would reduce left ventricular (LV) mass, reduce arterial stiffness and improve LV systolic and diastolic function in patients with stage 3 non-diabetic CKD.

Methods: This was a single-centre, randomised, double-blind, placebo-controlled trial (figure). All patients received sevelamer carbonate for four weeks before randomisation to sevelamer or placebo for a further 36 weeks. Cardiovascular magnetic resonance imaging and echocardiography were used to assess LV mass and systolic and diastolic function. Arterial stiffness was determined by carotid-femoral pulse wave velocity (PWV).

Results: A total of 120 patients were recruited. Mean age was 55 ± 14 years with 55% male and mean glomerular filtration rate 50 ± 13ml/min/1.73m². Mean baseline LV mass, function and volumes were normal. After 40 weeks there were no significant changes in LV mass (-1.0 ± 7.2 vs. -0.2 ± 6.6 grams, P=0.6), LV systolic and diastolic function or PWV between sevelamer and placebo groups (table). Despite regular monitoring only 56% of subjects took ≥80% of prescribed therapy.

Conclusion: In patients with stage 3 non-diabetic CKD, 40 weeks of treatment with sevelamer carbonate did not improve LV mass, LV systolic and diastolic function, or arterial stiffness.