Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Nephron Clin Pract 2008;110:c273–c283 DOI: 10.1159/000170783 Phosphate Binder Impact on Bone Remodeling and Coronary Calcification – Results from the BRiC Study Daniela Veit Barreto a Fellype de Carvalho Barreto a Aluízio Barbosa de Carvalho a Lilian Cuppari a Sérgio Antonio Draibe a Maria Aparecida Dalboni a Rosa Maria Affonso Moyses b Kátia Rodrigues Neves b Vanda Jorgetti b Marcio Miname c Raul D. Santos c Maria Eugênia Fernandes Canziani a Division of Nephrology, Department of Internal Medicine, a Federal University of São Paulo and b University of São Paulo, and c The Lipid Clinic of the Instituto do Coração (InCor, Heart Institute), University of São Paulo, São Paulo, Brazil p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevela- mer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 8 5.9 vs. 13.1 8 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 8 0.016 vs. 0.062 8 0.078, p = 0.003 for calcium and 0.017 8 0.016 vs. 0.071 8 0.084 m 3 / m 2 /day, p = 0.010 for sevelamer). Conclusions: There was no differ- ence in CAC progression or changes in bone remodeling be- tween the calcium and the sevelamer groups. Copyright © 2008 S. Karger AG, Basel Introduction Arterial calcification is a very common complication of chronic kidney disease, and predicts cardiovascular morbidity and mortality in these patients [1, 2]. Observa- tional and experimental studies have suggested that ab- normalities in mineral metabolism, including distur- bances in calcium-phosphate regulation [3–5] and chang- es in bone remodeling [6] may play a role in the pathogenesis of arterial calcification. Additionally, ex- Key Words Cardiovascular disease  Hemodialysis  Phosphate binders  Renal osteodystrophy  Vascular calcification Abstract Background and Aims: Calcium-containing phosphate binders have been shown to increase the progression of vas- cular calcification in hemodialysis patients. This is a prospec- tive study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histol- ogy. Methods: 101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice cor- onary tomographies and bone biopsies at entry and 12 months. Results: The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hor- mone (498 8 352 vs. 326 8 236 pg/ml, p = 0.017), bone al- kaline phosphatase (38 8 24 vs. 28 8 15 U/l, p = 0.03) and deoxypyridinoline (135 8 107 vs. 89 8 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 8 21 vs. 91 8 28 mg/dl, p = 0.015). Phosphorus (5.8 8 1.0 vs. 6 8 1.0 mg/dl, p = 0.47) and calcium (1.27 8 0.07 vs. 1.23 8 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, Received: April 1, 2008 Accepted: July 16, 2008 Published online: November 12, 2008 Maria Eugênia F. Canziani Rua Pedro de Toledo, 282 São Paulo, SP 04039-000 (Brazil) Tel. +55 11 5571 3261, Fax +55 11 5572 1862 E-Mail dialisefor@uol.com.br © 2008 S. Karger AG, Basel 1660–2110/08/1104–0273$24.50/0 Accessible online at: www.karger.com/nec