Ea. Slatopolsky et al., RenaGel (R), a nonabsorbed calcium- and aluminum-free phosphate binder, lowers serum phosphorus and parathyroid hormone, KIDNEY INT, 55(1), 1999, pp. 299-307
Background. This multicenter, open-label, dose-titration study assessed the
safety and efficacy of RenaGel(R), a nonabsorbed calcium- and aluminum-fre
e phosphate binder, in lowering serum phosphorus. Secondary outcomes were i
ts effects on serum intact parathyroid hormone (iPTH) and serum lipids.
Methods. Phosphate binders were discontinued during a two-week washout peri
od. Patients whose serum phosphorus was more than 6.0 mg/dl during washout
were eligible for treatment. RenaGel(R), at starting doses of two, three, o
r four 440 mg capsules three times per day with meals, was administered to
172 hemodialysis patients for eight weeks. RenaGel(R) could be increased by
one capsule per meal every two weeks as necessary to achieve serum phospho
rus control. A second two-week washout period followed.
Results. Mean serum phosphorus rose from 6.8 +/- 2.0 mg/dl at prewashout to
9.1 +/- 2.4 mg/dl at the end of the washout period. It then declined to 6.
6 +/- 1.9 mg/dl by the end of the eight-week RenaGel(R) treatment period (P
< 0.0001). Serum phosphorus increased to 8.0 +/- 2.2 mg/dl at the end of t
he second washout period. The mean dose at the end of RenaGel(R) treatment
was 5.4 g per day. Eighty-four percent of the patients previously used calc
ium-based phosphate binders. As expected, calcium declined during the initi
al washout period when calcium-based phosphate binders were discontinued. M
ean serum calcium declined from 9.6 +/- 1.0 mg/dl at prewashout to 9.1 +/-
0.8 mg/dl after washout. It then increased to 9.4 +/- 0.9 mg/dl by the end
of RenaGel(R) treatment. Median serum iPTH increased during the two-week wa
shout from 208 pg/ml to 316 pg/ml and then declined to 224 pg/ml at the end
of the eight-week treatment period (P < 0.0001 vs. end of initial washout)
. After eight weeks of treatment, RenaGel(R) reduced mean serum total chole
sterol from 171.0 +/- 43.1 mg/dl to 145.0 +/- 38.7 mg/dl (P < 0.0001) and m
ean serum low-density lipoprotein cholesterol from 102.0 +/- 34.9 mg/dl to
75.6 +/- 29.4 mg/dl (P < 0.0001). High-density lipoprotein cholesterol, tri
glycerides, and serum albumin did not change.
Conclusions. RenaGel(R), a novel and calcium- plus aluminum-free effective
phosphate binder, can control serum phosphorus and reduce the levels of PTH
and cholesterol without inducing hypercalcemia or other side effects. Thus
, this new phosphate binder may be effective in the treatment of renal oste
odystrophy in uremic patients.