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Basutkar RS, Varghese R, Mathew NK, Sankar Indira P, Viswanathan B, Sivasankaran P. Systematic review and meta-analysis of potential pleiotropic effects of sevelamer in chronic kidney disease: Beyond phosphate control. Nephrology (Carlton) 2021; 27:337-354. [PMID: 34882904 DOI: 10.1111/nep.14011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
Sevelamer, has been shown to have many pleiotropic actions on lipid panel, various inflammatory markers, and blood glucose levels in chronic kidney disease patients. We conducted a systematic review and meta-analysis to compare these pleiotropic effects of sevelamer to other phosphate binders used in chronic kidney disease patients. The relevant randomized controlled trials published from 1 January 2001 to 31 November 2019 on the following databases: Cochrane Central Register of Controlled Trials published in The Cochrane Library, PubMed, Scopus and Google Scholar were identified. All the included studies were independently assessed for eligibility and risk of bias. The modified data extraction form of Cochrane was used. This review included 44 studies for qualitative analysis and 28 reports for quantitative analysis. A meta-analysis of three studies (n = 180) showed that glycated haemoglobin had significantly decreased in sevelamer-treated patients (MD: 0.5%; p = <.001). Compared with calcium-based phosphate binders, sevelamer showed a significant reduction in low-density lipoprotein (MD: -19.43 mg/dL; p = <.001) and total cholesterol (MD: -19.98 mg/dL; p < .001). A significant increase in high-density lipoprotein (MD: 1.29 mg/dL; p = .05) was also prominent in sevelamer treated patients. However, we were not able to observe a significant change in other biochemical parameters such as TG, CRP, hs-CRP, FGF-23, IL-6 and albumin as, no statistically significant difference was observed.
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Affiliation(s)
- Roopa Satyanarayan Basutkar
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Tamil Nadu, India
| | - Resia Varghese
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Tamil Nadu, India
| | - Nina Kallanthanath Mathew
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Tamil Nadu, India
| | - Prithika Sankar Indira
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Tamil Nadu, India
| | | | - Ponnusankar Sivasankaran
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Tamil Nadu, India
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Riccio E, Sabbatini M, Bruzzese D, Grumetto L, Marchetiello C, Amicone M, Andreucci M, Guida B, Passaretti D, Russo G, Pisani A. Plasma p-cresol lowering effect of sevelamer in non-dialysis CKD patients: evidence from a randomized controlled trial. Clin Exp Nephrol 2017; 22:529-538. [PMID: 29159529 DOI: 10.1007/s10157-017-1504-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/31/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The accumulation of p-cresol, a metabolic product of aromatic amino acids generated by intestinal microbiome, increases the cardiovascular risk in chronic kidney disease (CKD) patients. Therefore, therapeutic strategies to reduce plasma p-cresol levels are highly demanded. It has been reported that the phosphate binder sevelamer (SEV) sequesters p-cresol in vitro, while in vivo studies on dialysis patients showed controversial results. Aim of our study was to evaluate the effect of SEV on p-cresol levels in non-dialysis CKD patients. METHODS This was a single-blind, randomized placebo-controlled trial (Registration number NCT02199444) carried on 69 CKD patients (stage 3-5, not on dialysis), randomly assigned (1:1) to receive either SEV or placebo for 3 months. Total p-cresol serum levels were evaluated at baseline (T0), and 1 (T1) and 3 months (T3) after treatment start. The primary end-point was to evaluate the effect of SEV on p-cresol levels. RESULTS Compared to baseline (T0, 7.4 ± 2.7 mg/mL), p-cresol mean concentration was significantly reduced in SEV patients after one (- 2.06 mg/mL, 95% CI - 2.62 to - 1.50 mg/mL; p < 0.001) and 3 months of treatment (- 3.97 mg/mL, 95% CI - 4.53 to - 3.41 mg/mL; p < 0.001); no change of plasma p-cresol concentration was recorded in placebo-treated patients. Moreover, P and LDL values were reduced after 3 months of treatment by SEV but not placebo. CONCLUSIONS In conclusion, our study represents the first evidence that SEV is effective in reducing p-cresol levels in CKD patients in conservative treatment, and confirms its beneficial effects on inflammation and lipid pattern.
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Affiliation(s)
- Eleonora Riccio
- Department of Nephrology, Second University of Naples, Naples, Italy.
| | - Massimo Sabbatini
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Dario Bruzzese
- Chair of Statistics, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Lucia Grumetto
- Department of Pharmacy, School of Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Cristina Marchetiello
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Maria Amicone
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Michele Andreucci
- Unit of Nephrology, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Bruna Guida
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Davide Passaretti
- Department of Economics and Law, University of Cassino and Southern Lazio, Cassino, Italy
| | - Giacomo Russo
- Department of Pharmacy, School of Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Antonio Pisani
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
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do Carmo WB, Castro BBA, Rodrigues CA, Custódio MR, Sanders-Pinheiro H. Chitosan-Fe (III) Complex as a Phosphate Chelator in Uraemic Rats: A Novel Treatment Option. Basic Clin Pharmacol Toxicol 2017; 122:120-125. [PMID: 28727296 DOI: 10.1111/bcpt.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/12/2017] [Indexed: 11/28/2022]
Abstract
Phosphate retention and hyperphosphataemia are associated with increased mortality in patients with chronic kidney disease (CKD). We tested the use of cross-linked iron chitosan III (CH-FeCl) as a potential phosphate chelator in rats with CKD. We evaluated 96 animals, divided equally into four groups (control, CKD, CH-FeCl and CKD/CH-FeCl), over 7 weeks. We induced CKD by feeding animals an adenine-enriched diet (0.75% in the first 4 weeks and 0.1% in the following 3 weeks). We administered 30 mg/kg daily of the test polymer, by gavage, from the third week until the end of the study. All animals received a diet supplemented with 1% phosphorus. Uraemia was confirmed by the increase in serum creatinine in week 4 (36.24 ± 18.56 versus 144.98 ± 22.1 μmol/L; p = 0.0001) and week 7 (41.55 ± 22.1 versus 83.98 ± 18.56 μmol/L; p = 0.001) in CKD animals. Rats from the CKD group treated with CH-FeCl had a 54.5% reduction in serum phosphate (6.10 ± 2.23 versus 2.78 ± 0.55 mmol/L) compared to a reduction of 25.6% in the untreated CKD group (4.75 ± 1.45 versus 3.52 ± 0.74 mmol/L, p = 0.021), between week 4 and week 7. At week 7, renal function in both CKD groups was similar (serum creatinine: 83.98 ± 18.56 versus 83.10 ± 23.87 μmol/L, p = 0.888); however, the CH-FeCl-treated rats had a reduction in phosphate overload measured by fractional phosphate excretion (FEPi) (0.71 ± 0.2 versus 0.4 ± 0.16, p = 0.006) compared to the untreated CKD group. Our study demonstrated that CH-FeCl had an efficient chelating action on phosphate.
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Affiliation(s)
- Wander Barros do Carmo
- Division of Clinical Medicine of the Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Laboratory Animal Studies (NIDEAL), Center for Reproductive Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Bárbara Bruna Abreu Castro
- Interdisciplinary Center for Laboratory Animal Studies (NIDEAL), Center for Reproductive Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Clóvis Antônio Rodrigues
- Nucleus of Chemical-Pharmaceutical Research (NIQFAR) of the University of Vale do Itajaí, Itajaí, Brazil
| | | | - Helady Sanders-Pinheiro
- Interdisciplinary Center for Laboratory Animal Studies (NIDEAL), Center for Reproductive Biology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Interdisciplinary Center for Studies and Research in Nephrology (NIEPEN), Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Holt SG, Smith ER. Fetuin-A-containing calciprotein particles in mineral trafficking and vascular disease. Nephrol Dial Transplant 2016; 31:1583-7. [PMID: 27190332 DOI: 10.1093/ndt/gfw048] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/18/2016] [Indexed: 11/14/2022] Open
Abstract
Calcium and phosphate combine to form insoluble precipitates in both inorganic and organic materials. This property is useful biologically and has been used by numerous organisms to create hard tissues, a process referred to as biomineralisation [1]. In humans, calcium and phosphate combine to form useful crystal structures largely composed of calcium hydroxyapatite [Ca10(PO4)6(OH)2] and these are essential in the growth, maintenance and strength of parts of the skeleton and other structures like teeth. However, it remains unclear how the body achieves the exquisite specificity involved in biomineralisation. In ageing and disease, these pathways are perturbed, resulting in ectopic calcium crystal deposition impairing tissue function and, interestingly, frequently accompanied by simultaneous loss of mineral from sites where it is useful (e.g. bone). One paradigm for this maladaptive situation is renal failure; a situation that we know is associated with vascular stiffening and calcification, along with mineral loss from the skeleton. Mineral trafficking is a loose term used to describe the movements of calcium salts around the body, and new insights into these pathways may explain some of the problems of previous models of bone mineral disease in renal failure and point to potential future therapeutic strategies.
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Affiliation(s)
- Stephen G Holt
- Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia Melbourne University, Melbourne Medical School, Level 2 (Street level), West Wing, Medical Building 181, Parkville, VIC 3050, Australia
| | - Edward R Smith
- Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia
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Chen FY, Gu ZJ, Yi JW, Xu XZ, Kulkarni P, Tang Q. The evaluation of lanthanum trapped prussian blue as a phosphate binding agent with reduced bone uptake. NEW J CHEM 2016. [DOI: 10.1039/c5nj03126e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Lanthanum trapped Prussian blue is developed as a two-process-independent phosphate binder with the main feature of reduced lanthanum accumulation.
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Affiliation(s)
- Fei-Yan Chen
- College of Chemistry
- Nanchang University
- Nanchang
- China
| | - Zhe-Jia Gu
- Institute for Advanced Study
- Nanchang University
- Nanchang
- China
| | - Jing-Wei Yi
- Institute for Advanced Study
- Nanchang University
- Nanchang
- China
| | - Xian-zhu Xu
- College of Life Science
- Jiangxi Normal University
- Nanchang
- China
| | | | - Qun Tang
- Institute for Advanced Study
- Nanchang University
- Nanchang
- China
- Department of Radiology
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Li J, Yu F, Chen Y, Oupický D. Polymeric drugs: Advances in the development of pharmacologically active polymers. J Control Release 2015; 219:369-382. [PMID: 26410809 DOI: 10.1016/j.jconrel.2015.09.043] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
Synthetic polymers play a critical role in pharmaceutical discovery and development. Current research and applications of pharmaceutical polymers are mainly focused on their functions as excipients and inert carriers of other pharmacologically active agents. This review article surveys recent advances in alternative pharmaceutical use of polymers as pharmacologically active agents known as polymeric drugs. Emphasis is placed on the benefits of polymeric drugs that are associated with their macromolecular character and their ability to explore biologically relevant multivalency processes. We discuss the main therapeutic uses of polymeric drugs as sequestrants, antimicrobials, antivirals, and anticancer and anti-inflammatory agents.
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Affiliation(s)
- Jing Li
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Fei Yu
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yi Chen
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - David Oupický
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA; Department of Chemistry, University of Nebraska Lincoln, Lincoln, NE, USA; Department of Pharmaceutical Sciences, China Pharmaceutical University, Nanjing, China.
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Chellan P, Sadler PJ. The elements of life and medicines. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2015; 373:20140182. [PMID: 25666066 PMCID: PMC4342972 DOI: 10.1098/rsta.2014.0182] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Which elements are essential for human life? Here we make an element-by-element journey through the periodic table and attempt to assess whether elements are essential or not, and if they are, whether there is a relevant code for them in the human genome. There are many difficulties such as the human biochemistry of several so-called essential elements is not well understood, and it is not clear how we should classify elements that are involved in the destruction of invading microorganisms, or elements which are essential for microorganisms with which we live in symbiosis. In general, genes do not code for the elements themselves, but for specific chemical species, i.e. for the element, its oxidation state, type and number of coordinated ligands, and the coordination geometry. Today, the biological periodic table is in a position somewhat similar to Mendeleev's chemical periodic table of 1869: there are gaps and we need to do more research to fill them. The periodic table also offers potential for novel therapeutic and diagnostic agents, based on not only essential elements, but also non-essential elements, and on radionuclides. Although the potential for inorganic chemistry in medicine was realized more than 2000 years ago, this area of research is still in its infancy. Future advances in the design of inorganic drugs require more knowledge of their mechanism of action, including target sites and metabolism. Temporal speciation of elements in their biological environments at the atomic level is a major challenge, for which new methods are urgently needed.
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Affiliation(s)
- Prinessa Chellan
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, UK
| | - Peter J Sadler
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, UK
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