Year: 2026 | Month: January-March | Volume: 11 | Issue: 1 | Pages: 289-298
DOI: https://doi.org/10.52403/ijshr.20260130
Comparative Study of Efficacy and Safety of Sevelamer versus Calcium Acetate in CKD-Related Hyperphosphatemia
Murli Manohar1, Santosh Kumar2, Rishi Kishore3, Asha Singh4, Arun Kumar5
1Associate Professor, 2Tutor/Senior Resident, 3Assistant Professor, 4Professor & Head, Department of Pharmacology NMC, Patna
5Assistant Professor, Department of Pharmacology VRIMS, Koyla, Belwa, East Champaran
Corresponding Author: Dr. Arun Kumar
ABSTRACT
Background: Hyperphosphatemia is a critical complication in chronic kidney disease (CKD), contributing to cardiovascular morbidity. While calcium-based binders are effective, they carry a risk of hypercalcemia and vascular calcification. This study compares the efficacy and safety of sevelamer versus calcium acetate in managing CKD-related hyperphosphatemia.
Methods: This prospective, randomized, open-label trial enrolled 100 patients with CKD stages 4-5 and persistent hyperphosphatemia (>5.5 mg/dL). Patients were randomized to receive sevelamer (800 mg thrice daily, n=50) or calcium acetate (667 mg thrice daily, n=50) for 12 weeks. The primary outcome was the change in serum phosphate levels. Secondary outcomes included changes in serum calcium, calcium-phosphate (Ca x P) product, lipid profile, and incidence of adverse events.
Results: Baseline characteristics were similar between groups. At week 12, sevelamer resulted in a significantly greater mean reduction in serum phosphate from baseline compared to calcium acetate (2.04 ± 0.87 vs. 1.53 ± 0.91 mg/dL; p=0.0051). The incidence of hypercalcemia was significantly lower with sevelamer (4% vs. 20%; p=0.0277). Furthermore, sevelamer demonstrated a significant reduction in LDL cholesterol (-18.07 ± 12.86 mg/dL) compared to minimal change with calcium acetate (-2.11 ± 10.26 mg/dL; p<0.0001). A strong trend toward reduced progression of vascular calcification was observed with sevelamer (8% vs. 24%; p=0.0538).
Conclusion: Sevelamer is more effective than calcium acetate in lowering serum phosphate and offers significant advantages in reducing the risk of hypercalcemia and improving the lipid profile. These benefits support its preferential use in CKD patients at high cardiovascular risk.
Keywords: Sevelamer, Calcium Acetate, Hyperphosphatemia, Chronic Kidney Disease, Vascular Calcification