EFFECT OF SEVELAMER AND CALCIUM ACETATE ON FGF-23 LEVELS IN NON-DIABETIC CKD PATIENTS: AN OBSERVATIONAL STUDY.

Abstract

Elevated FGF-23 is the earliest and most common manifestation of disordered mineral metabolism in chronic kidney disease. Phosphate binders are routinely prescribed to lower FGF-23 levels and to reduce the risk of morbidity related to imbalance in bio-chemical parameters. This study was designed to compare the efficacy of calcium acetate to sevelamer in reducing FGF-23 levels in patients with chronic kidney disease.
An observational study of 810 patients of chronic kidney disease divided into two groups of 405 each was conducted in SRN Hospital during July 2017 to August 2019. Sevelamer 800 mg and 667 mg calcium acetate were given to group 1 and group 2 respectively in order to compare the efficacy of sevelamer to calcium acetate in reducing the FGF-23 levels in patients with chronic kidney disease. Statistical analysis was performed using descriptive statistics and repeated measure ANOVA-One way by IBM SPSS 24.
A statistically significant change in FGF-23 levels and other parameters like calcium, phosphorus and intact PTH was observed in treatment with both sevelamer as well as calcium acetate. However, the patients who were prescribed sevelamer exhibited with a remarkable tendency to have a greater reduction in mean FGF-23 levels from 0 to 6 months and 6 to 9 months (33.72 8.77 and 2.17 16.98) as compared to those who were prescribed calcium acetate (75.18 0.03 and 178.11 15.80) respectively.
Our study clearly establishes the superiority of sevelamer over calcium acetate in reducing FGF-23 levels and in achieving the target levels of calcium, phosphorus and iPTH clinically and statistically leading us to conclude the possibility of sevelamer being a viable therapeutic alterative in patients of chronic kidney disease.
Keywords: Sevelamer, calcium acetate, FGF-23, chronic kidney disease.