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Background: Tumour lysis syndrome is associated with high levels of uric acid, phosphate and potassium along with low levels of calcium and abnormal renal function. Sevelamer, an oral phosphate-binder is used in the treatment of hyperphosphatemia in children and adults on hemodialysis. Case characteristics: Two children with T-cell acute lymphoblastic leukemia who presented with a high tumour load and developed tumour lysis syndrome. Observation: Both children received Rasburicase and Sevelamer hydrochloride. The serum phosphate reduced to normal levels within 24-48 hrs of initiation of sevelamer hydrochloride. Message: Sevelamer appears to be an effective treatment for hyperphosphatemia associated with tumour lysis syndrome.
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Objective To evaluate the short-term efficacy and safety of sevelamer hydrochloride in treating maintenance hemodialysis (MHD) patients with hyperphosphemia.Methods A multicenter,open-labeled,self-control study was performed.Phosphate binders were discontinued during a two-week washout period.Patients with more than 1.78 mmol/L serum phosphorus after two-week washout period were eligible for the trial.The dose was adjusted every two weeks as necessary to achieve serum phosphorus control. Sevelamer hydrochloride was administered to 138 MHD patients for 10 weeks and a second two-week washout period followed.Results A total of 111 from 138 patients fulfilled the whole 14-week study. Mean serum phosphorus and calcium-phosphate products starte to decline after two-week sevelamer hydrochloride treatment. By the end of 10-week sevelamer hydrochloride treatment, mean serum level of phosphorus [(1.85±0.50) vs (2.57±0.54) mmol/L,P＜0.01],calcium-phosphate product [(4.16± 1.72) vs (5.79 ± 1.50) mmol2/L2,P＜0.01 ] and low density lipoprotein [(1.64±0.76) vs (2.31 ±0.87) mmol/L,P＜0.01] were significantly decreased,while the adjusted serum level of calcium and serum intact parathyroid hormone kept steady.Both serum phosphorus and calcium-phosphrus product increased after the second washout period, but the levels were still lower as compared to pre-treatment [(2.26±0.71) vs (2.57±0.54) mmol/L; (5.12±1.63) vs (5.79±1.50) mmol2/L2,P＜0.01].Of the 138 patients involved,214 episodes in 106 patients and 121 episodes in 89 patients were reported as adverse events and adverse drug reaction respectively. Gastrointestinal symptoms,of which most were mild or moderate,happened to 68.1％ (94/138) patients. Conclusions Sevelamer hydrochloride can control serum phosphorus and reduce the levels of calcium-phosphorus product and cholesterol.Slight gastrointestinal symptoms like constipation are common during the treatment.
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Calciphylaxis is a rare, but serious disorder that is usually observed in patients with renal disease and secondary hyperparathyroidism. It is characterized by the ischemic necrosis of the skin, the underlying tissue and other organs, as well as rapid vascular calcification. Prompt diagnosis and management is required because the intractable skin necrosis sometimes causes lethal sepsis. Sevelamer hydrochloride is an ion-exchanging resin that binds phosphates in the gut without increasing the calcium load. Treatment with it may lead to less vascular calcification and better survival for patients with chronic renal disease. Herein we present a case of calciphylaxis with renal failure and the patient improved after treatment with sevelamer hydrochloride therapy.