Sevelamer carbonate

Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, safety data, and place in therapy of sevelamer carbonate for the treatment of hyperphosphatemia in patients with chronic kidney disease (CKD).

Data sources: A literature search of MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations Databases (1966-August 2009) was conducted using the key words chronic kidney disease, hyperphosphatemia, and sevelamer carbonate. All published articles regarding sevelamer carbonate were included. References of selected articles, data from multiple presentations, and abstract publications were reviewed.

Study selection and data extraction: Available English-language data from reviews, abstracts, presentations, and clinical trials of sevelamer carbonate in humans were reviewed; relevant clinical data were selected and included.

Data synthesis: Sevelamer carbonate is approved to control serum phosphorus levels and treat hyperphosphatemia in patients with CKD who are on dialysis. In clinical trials, sevelamer carbonate has been shown to lower serum phosphorus levels and calcium-phosphorus product to a similar extent as sevelamer hydrochloride. Significantly fewer patients receiving treatment with sevelamer carbonate were likely to report any gastrointestinal adverse event compared with those on sevelamer hydrochloride treatment. Further, sevelamer carbonate is associated with significant effects on decreasing low-density lipoprotein Cholesterol levels and may cause less metabolic acidosis than sevelamer hydrochloride. Additionally, sevelamer hydrochloride was removed from the market in October 2009; sevelamer carbonate is now the only available formulation.

Conclusions: Sevelamer carbonate is a treatment option for hyperphosphatemia in patients with CKD who are on dialysis. Clinical data indicate that sevelamer carbonate effectively lowers serum phosphorus levels while having minimal effect on serum calcium or serum chloride levels. The role of sevelamer carbonate in the treatment of hyperphosphatemia relative to other phosphate-binding drugs, including calcium salts and lanthanum, has not yet been established.