Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Nephron Clin Pract 2011;117:c83–c88 DOI: 10.1159/000319654 Effect of Sevelamer Hydrochloride Exposure on Carotid Intima Media Thickness in Hemodialysis Patients M. Boaz   a Z. Katzir   b D. Schwartz   c, d U. Gafter   d, e A. Biro   b L. Shtendik   b V. Kon   c G. Chernin   c T. Weinstein   c, d a  Epidemiology and Research Unit, b  Institute of Nephrology, E. Wolfson Medical Center, Holon, c  Department of Nephrology, Tel Aviv Medical Center, d  Tel Aviv University Medical School, Tel Aviv, and e  Department of Nephrology, Rabin Medical Center, Petah Tikvah, Israel model even after controlling for potentially confounding variables including serum Ca, history of CVD and body weight. Exposed subjects had lower low-density lipoprotein cholesterol levels and significantly higher parathyroid hor- mone, but no differences in P, Ca and Ca ! P. Conclusions: Sevelamer hydrochloride was associated with lower carotid IMT. This association may be mediated through reduction in Ca load, low-density lipoprotein cholesterol lowering or some other pleiotropic effect. Copyright © 2010 S. Karger AG, Basel Introduction Chronic kidney disease (CKD) is accompanied by mineral metabolism disturbances, which include in- creased serum phosphorus (P) and parathyroid hormone (PTH) levels, and decreased vitamin D. Causes of elevat- ed serum P in hemodialysis (HD) patients have been ex- tensively reviewed by Block et al. [1] and include increased dietary P intake inherent in the high protein HD dietary recommendations, increased P absorption with vitamin Key Words Sevelamer hydrochloride  Intima media thickness  Cardiovascular disease  Chronic kidney disease  Carotid artery  Femoral artery Abstract Background: Elevated phosphorus (P) and calcium (Ca)-P product (Ca ! P) are associated with vascular calcification and cardiovascular disease (CVD) morbidity and CVD and all- cause mortality. Objectives: This study examined the effect of sevelamer hydrochloride exposure (regardless of calcium carbonate exposure) on carotid and femoral intima media thickness (IMT), reliable surrogate measures of prospective intimal thickening, in end-stage renal disease patients on maintenance hemodialysis. Methods: The present cross- sectional study is nested in the Sevelamer hydrochloride and ultrasound-measured femoral and carotid intima media thickness progression in end-stage renal disease (SUMMER) clinical trial. Carotid and femoral arteries were visualized in B-mode ultrasonography. Log-transformed IMT was com- pared by sevelamer hydrochloride exposure and modeled using multiple linear regression. Results: Forty-five subjects were exposed to sevelamer hydrochloride and 130 were not. Exposed subjects had significantly lower carotid IMT, an as- sociation which persisted in the multiple linear regression Received: January 25, 2010 Accepted: April 8, 2010 Published online: August 6, 2010 Talia Weinstein, MD, PhD Department of Nephrology Tel Aviv Medical Center 6 Weizman Street, Tel Aviv 64239 (Israel) Tel. +972 3 697 3443, Fax +972 3 546 9825, E-Mail tweinste  @  post.tau.ac.il © 2010 S. Karger AG, Basel 1660–2110/11/1172–0083$38.00/0 Accessible online at: www.karger.com/nec M.B. and T.W. received a research grant from Genzyme, USA. T.W. re- ceived an honorarium from Genzyme, USA.