Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel.
Nephron Clin Pract. 2011;117(2):c83-8. doi: 10.1159/000319654. Epub 2010 Aug 6.
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.
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.
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 compared by sevelamer hydrochloride exposure and modeled using multiple linear regression.
Forty-five subjects were exposed to sevelamer hydrochloride and 130 were not. Exposed subjects had significantly lower carotid IMT, an association which persisted in the multiple linear regression 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 hormone, but no differences in P, Ca and Ca × P.
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.
升高的磷 (P) 和钙 (Ca)-P 产物 (Ca × P) 与血管钙化和心血管疾病 (CVD) 发病率以及 CVD 和全因死亡率相关。
本研究检测了盐酸司维拉姆暴露（无论是否暴露碳酸钙）对维持性血液透析的终末期肾病患者颈动脉和股动脉内膜中层厚度（IMT）的影响，IMT 是内膜进行性增厚的可靠替代指标。
本横断面研究嵌套在盐酸司维拉姆和超声测量的终末期肾病患者股动脉和颈动脉内膜中层厚度进展研究（SUMMER）临床试验中。采用 B 型超声对颈动脉和股动脉进行可视化。采用多线性回归模型比较盐酸司维拉姆暴露的对数转换 IMT。
45 例患者暴露于盐酸司维拉姆，130 例患者未暴露于盐酸司维拉姆。暴露组的颈动脉 IMT 明显较低，即使在控制血清 Ca、CVD 病史和体重等潜在混杂变量后，这种关联在多线性回归模型中仍然存在。暴露组的低密度脂蛋白胆固醇水平较低，甲状旁腺激素水平明显较高，但 P、Ca 和 Ca × P 无差异。
盐酸司维拉姆与较低的颈动脉 IMT 相关。这种关联可能通过降低 Ca 负荷、降低低密度脂蛋白胆固醇或其他多效性作用来介导。
