Effects of Nicotinic Acid and Sevelamer on Hyperphosphatemia in the Hemodialysis Patients: A Double Blind Clinical Trial
DOI:
https://doi.org/10.22100/jkh.v11i1.756Keywords:
Nicotinic acid, Sevelamer carbonate, Hyperphosphatemia, HemodialysisAbstract
Introduction: Control of the phosphorus in dialysis’ patients is very important and can be done in many ways. The purpose of the study is to determine the effect of Nicotinic acid (Niacin) and Sevelamer on the serum phosphorus of hemodialysis patients.
Methods: This double-blind randomized clinical trial study includes two groups: 60 patients (taking Niacin) and 60 patients control groups (taking Sevelamer).Niacin dose was increasing monthly in three steps from 200 to 600 mg and Sevelamer from 400 to 1200 mg. Serum phosphorus was measured in the both groups and the results were compared. In this study P<0.05 was significant.
Results: A total of 120 patients attending in this study, mean age of case group were 51.5± 21.3 years and control group was 50.7± 22.5 years that no have difference. Phosphor level in starter study in case group was 6.67±1.37 mg/dl and control group was 6.77±0.95 mg/dl that no has difference. Niacin significantly decreased the blood phosphorus levels (P<0.001) that with increasing the dose of niacin, this decreasing was more than Sevelamer.
Conclusion: Nicotinic acid can decrease serum phosphorous; however, it is need a longer trial study for determining the most effective doses of the Nicotinic acid.
References
Amerian M, Sohrabi MB, Zolfaghari P,Yarmohammadi M, Nezakati E, Yahyaei E, et al. Effects of niasine on serum phosphorus, PTH and lipid profile in the hemodialysis patients in Shahroud city. Medical Sciences Journal of Islamic Azad University, Tehran Medical Branch 2015;24:221-6.[Persian].
Berns JS. Niacin and related compounds for treating hyperphatemia in dialysis patients. Semin Dial 2013;21:203-5.
Fukagawa M, Nakanishi S, Kazama JJ. Basic and clinical aspect of parathyroid hyperplasia in chronic kidney disease. Kidney Intt 2012; 20:53-7.
Dusso AS, Sato T, Arcidiacono MV, Álvarez-Hernández D, Yang J, Gonzáles-Suárez I,et al. Pathogenic mechanisms for parathyroid hyperplasia. Kidney Int Suppl 2006;70:S8-11.
Bellasi A, Kooienga L, Block GA. Phosphate binders: new products and challenges. Hemodialysis Int 2013;10:225-34.
Foley RN, Murray AM, Li S. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the united states medicare population, 1998 to 1999. J Am Soc Nephrol 2012; 16:489-95.
Ossareh S. Clinical and economic aspects of sevelamer therapy in end- stage renal disease patients. Int J Nephrol Renovasc Dis 2014; 7:161-8.
Tzanno-Martins C, Biavo BM, Ferreira-Filho O, Ribeiro-Junior E, João-Luiz MV, Degaspari S, et al. Clinical efficacy, safety and anti-inflammatory activity of two sevelamer tablet forms in patients on low-flux hemodialysis. Int J Immunopathol Pharmacol 2014;27:25-35.
Oka Y, Miyazaki M, Matsuda H, Takatsu S, Katsube R, Mori T, et al. Sevelamer hydrochloride dose-dependent increase in prevalence of severe acidosis in hemodialysis patients: analysis of nationwide statistical survey in Japan. Ther Apher Dial 2014;18:37-43.
Eto N, Miyata Y, Ohno H, Yamashita T. Nicotinamide prevent the development of hyperphosphataemia by suppressing intestinal sodium-dependent phosphate transporter in rats with adenina-induced renal failure. Nephrol Dial Transplant 2012;20:1378-84.
Debiec H, Lorenc R. Identification of Na, Pi-binding protein in kidney and intestinal brush-border membranes. Biochem J 2013; 25:185-191.
Field J, Zhang Li, Brun KA, Brooks DP, Edwards RM. Cloning and functional characterization of a sodium dependent phosphate transporter expressed in human lung and small intestine. Bioch Bioph Res Comm 2012;58:578-82.
Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO4, Ca X PO4 product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2012;12:2131-8.
Stevens LA, Djurdjev O, Cardew S, Cameron EC, Levin A. Calcium, phosphate and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol 2013;15:770-9.
Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol 2013;15:2208-18.
Young EW, Akiba T, Albert J. Magnitude and impact of abnormal mineral metabolism in hemodialysis patients in the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2014;44:34-8.
Kestenbaum B, Sampson JN, Rudser KD. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol 2012;16:520-8.
Pohlmeier R, Vienken J. Phosphate removal and hemodialysis conditions. Kidney Int 2013;29:190-4.
Slatopolsky E, Liapis H, Finch J. Progressive accumulation of lanthanum in the liver of normal and uremic rats. Kidney Int 2011; 18:2809-13.
Yusuf AA, Weinhandl ED, St Peter WL. Comparative effectiveness of calcium acetate and sevelamer on clinical outcomes in elderly hemodialysis patients enrolled in Medicare part D. Am J Kidney Dis 2014;64:95-103.
Chen N, Wu X, Ding X, Mei C, Fu P, Jiang G, et al. Sevelamer carbonate lowers serum phosphorus effectively in haemodialysis patients: a randomized, double-blind, placebo-controlled, dose-titration study. Nephrol Dial Transplant 2014;29:152-60.
Hatakeyama S, Murasawa H, Narita T, Oikawa M, Fujita N, Iwamura H, et al. Switching hemodialysis patients from sevelamer hydrochloride to bixalomer: a single-center, non-randomized analysis of efficacy and effects on gastrointestinal symptoms and metabolic acidosis. BMC Nephrol 2013;14:222.
Kuboyama N, Watanabe Y, Yamaguchi M, Sato K, Suzuki T, Akiba T. Effects of niceritrol on faecal and urinary phosphate excretion in normal rats. Nephrol Dial Transplant 2012;14:610-4.
Hattenhauer O, Traebert M, Murer H, Biber J. Regulation of small intestinal Na-Pi type IIb cotransporter by dietary phosphate intake. Am J Physiol 2011;27:756-62.
Bover J, Herbener O, Ballarín J, Andrés E, Barceló P. Nuevas estrategias para el hiperparatiroidismo secundario en diálisis (1): nuevos conceptos, nuevos tratamientos. Nefrología 2014;25:100-8.
Takahashi Y, Tanaka A, Nakamura T, Fukuwatari T, Shibata K, Shimada V, et al. Nicotinamide suppresses hyperphosphatemia in hemodialysis patients. Kidney Int 2012;15:1099-1104.
Shimoda K, Akiba T, Matsushima T, Rai T, Abe K, Hoshino M. Niceritrol decreases serum phosphate levels in hemodialysis patients. Nihon Jinzo Gakkai Shi 1998;40:1-7.
Shahapuni I, Rahmouni K, Harbouche L, El Esper N, Fournier A. Great cost effectiveness of nicotinamide compared with that sevelamer for controlling hyperphosphatemia in dialysis patients 2007. World Congress of Nephrology 2013;20:131-7.
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