Efficacy and safety of sevelamer. Comparison with calcium carbonate in thereatment of hyperphosphatemia in hemodialysis patients

Current phosphate binders used in hemodialysis patients include calcium-based binders that result in frequent hypercalcemia. The use of a calcium- and aluminum-free phosphate-binding polymer in hemodialysis [sevelamer] disclosed efficacy in the short and long-term studies. However, due to race differences we performed a short-term study on the Saudi hemodialysis patients and compared sevelamer with a standard calcium-based phosphate binder. An open-label, randomized, cross-over study was performed to evaluate the safety and effectiveness of sevelamer hydrochloride in controlling hyperphosphatemia in hemodialysis patients. After a 2-week phosphate binder washout period, stable hemodialysis patients were given either sevelamer or calcium carbonate, and the dosages were titrated to achieve phosphate control over an 8-week period. After a 2-week washout period, patients crossed over to the alternate agent for 8 weeks. Twenty patients from the Dialysis Unit of King Fahd Hospital, Jeddah, Kingdom of Saudi Arabia, were recruited for the study between March 2003 and June 2003. There was a similar decrease in serum phosphate values over the course of the study with both sevelamer [-3.3 +/- 2.2 mg/dL] and calcium carbonate [-3.9 +/- 2.8 mg/dL]. Fifty-two% of patients developed serum calcium greater than 2.75 mmol/L [11.0 mg/dL] while receiving calcium carbonate versus 26% of patients receiving sevelamer [p<0.05]. The incidence of hypercalcemia for sevelamer was not different from the incidence of hypercalcemia during the washout period. Patients treated with sevelamer also sustained a 13% mean decrease in serum cholesterol levels. Sevelamer was effective in controlling hyperphosphatemia without resulting in an increase in the incidence of hypercalcemia seen with calcium carbonate. This agent appears quite effective in the treatment of hyperphosphatemia in hemodialysis patients, and its usage may be advantageous in the treatment of dialysis patients

Impact of nephrology publications from Saudi Arabia in the last decade

To study the present situation with regards to the research output in Nephrology from the Kingdom of Saudi Arabia [KSA] in terms of numbers, type, institution and fields covered. An extensive Medline search of Nephrologists working in KSA, as well research output from KSA was undertaken; in addition, all Nephrologists were contacted. All papers appearing in the Saudi Medical Journal, Annals of Saudi Medicine and The Saudi Journal for Kidney Diseases and Transplantation were screened for the years 1992-2001. An average of 45 papers per year appeared over the last 10 years with no major changes over the years. Half were in the indexed Journals. Whereas, 61% were original articles, the majority of the papers [78.2%] were retrospective in nature and 89.9% were clinical. The majority were concerned with transplantation [34.1%] and hemodialysis [24.4%]. It is of interest to note that KSA leads other Arab countries in the number of publications in Nephrology and it has a highest total percentage of medical publications compared to other Arab, and Asian countries as well as the United Kingdom, Canada and United States of America. Although KSA is leading the Arab countries in renal research, much improvement is still required especially in basic research

Bacteraemia in relation to the type of vascular access in patients on hemodialysis

In 709 haemodialysis patients with acute and chronic renal failure the frequency of access infections was investigated in a retrospective 10-year follow-up study. In epicutaneous Quinton-Scribner shunts a positive bacteraemia was found in only 3% of the patients. In subcutaneous fistulas [Brescia-Cimino fistulas and vena saphena interponates] positive bacteraemia occurred in 12% whereas in PTFE protheses and vena cava catheters the infection rate was 40% and 42% respectively. Gram-positive bacteria caused access infections in 77% of cases, Staphylococcus aureus and S. epidermidis were the most frequent microorganisms. Therefore antibiotics active against Gram-positive bacteria are recommended in cases of access infections until the results of culture and sensitivity tests are available