The following is a summary of “Association of sevelamer initiation with gastrointestinal bleeding hospitalization in individuals requiring hemodialysis,” published in the March 2024 issue of Nephrology by Le et al.
Some individual cases have hinted that using sevelamer might lead to gastrointestinal bleeding, but no extensive observational studies have evaluated whether this is true or not.
Researchers conducted a retrospective study examining the association between the initiation of sevelamer, GIB hospitalization, and all-cause mortality among individuals on hemodialysis.
They used the United States Renal Data System database from 2015 to 2019 and emulated a target trial using Cox regression models and inverse probability of treatment weights to estimate the adjusted hazard ratios (HR) across outcomes and subgroups.
The results showed 21,354 new users of phosphate binders (11,276 sevelamer and 10,078 non-sevelamer); with baseline lab data (calcium, phosphorus, hemoglobin, and albumin), there were 2,811 GIB hospitalizations and 5,920 deaths over a median follow-up of 1.3 years. Sevelamer initiation did not show an increased risk of GIB hospitalization when compared to non-sevelamer binders (90 vs. 89 events per 1000 person-years; IPTW-HR 0.98, 95% CI 0.91-1.06) or all-cause mortality (220 vs. 224 events per 1000 person-years; IPTW-HR 0.98 95% CI 0.93-1.03) compared to non-sevelamer binders. Subgroup analyses, including diabetes and anti-coagulation use, yielded consistent results. Additionally, no association was observed between sevelamer dose and GIB hospitalization.
Investigators concluded that in patients getting hemodialysis, the initiation of sevelamer-containing phosphate binders did not demonstrate an elevated risk of GIB hospitalization compared to non-sevelamer binders.
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