Effects of Sevelamer on HbA1c, Inflammation, and Advanced Glycation End Products in Diabetic Kidney Disease

Clinical Journal of the American Society of Nephrology, 06/08/2012

Sevelamer carbonate significantly reduces HbA1c, fibroblast growth factor 23, lipids, and markers of inflammation and oxidative stress, and markedly increases antioxidant markers, independently of phosphorus in patients with diabetes and early kidney disease. These novel actions of sevelamer carbonate on metabolic and inflammatory abnormalities in type 2 diabetes mellitus may affect progression of early diabetic CKD.

Methods

  • This single-center, randomized, 2-month, open-label, intention-to-treat, crossover study compared sevelamer carbonate with calcium carbonate treatment in stage 2–4 diabetic CKD.
  • Participants received 2 months of treatment with one drug, had a 1-week washout, and then received the opposite drug for 2 months.

Results

  • Sevelamer carbonate reduced HbA1c, serum methylglyoxal, serum εN-carboxymethyl-lysine, triglycerides, and 8-isoprostanes.
  • Total cholesterol and fibroblast growth factor 23 were reduced by sevelamer carbonate, relative to calcium carbonate.
  • AGE receptor 1 and sirtuin 1 mRNA were increased and PMNC TNFα levels were decreased by sevelamer carbonate, but not calcium carbonate.
  • Medications and caloric and AGE intake remained unchanged.
  • Sevelamer carbonate reversibly bound AGE-BSA at intestinal, but not stomach, pH.

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