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Sevelamer carbonate in the management of hyperphosphatemia

L Kooienga and R Moore

Sevelamer carbonate appears to be a promising new agent in the control of serum phosphorus levels in subjects with chronic kidney disease. It contains the same active moiety as sevelamer hydrochloride, but has carbonate instead of chloride as the counterion. This substitution has resulted in a statistically significant improvement in serum bicarbonate levels in chronic kidney disease patients receiving chronic dialysis, and may support, in the future, the treatment of hyperphosphatemia in chronic kidney disease patients not yet on dialysis. It also offers the potential for improved gastrointestinal tolerability and the prospect of alternative formulations, such as a powder. However, most of the proposed benefits of sevelamer carbonate are extrapolated from the studies completed with sevelamer hydrochloride. Hence, the determination of an added benefit from sevelamer carbonate compared with sevelamer hydrochloride and other phosphorus binders will require direct comparison.