when to start sevelamer

  • Correct Ca x phosphorus > 55

Hyperphosphatemia has been clearly shown to play a major role in the pathogenesis of secondary hyper-parathyroidism, extraosseous calcification, and increased mortality risk in hemodialysis patients. Serum phosphorus exceeding 5.5 mg/dL and calcium phosphate product (Ca × P) over 52 mg2/dL2 each correlate with increased mortality risk in dialysis patients. These findings have led to the recent publication of the National Kidney by the International Society of Nephrology Foundation Kidney Disease Outcome and Quality Initiative (K/DOQI) Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease, which recommend more rigorous control of serum phosphorus to levels between 3.5 and 5.5 mg/dL, while maintainingaining Ca × P product less than 55 mg2/dL2.

  • Start at 800 TID and uptitrate to 2400 TID
  • SE: constipation and nausea
  • CARE study