Effects of sevelamer on HbA1c, inflammation, and advanced glycation end products in diabetic kidney disease

Helen Vlassara, Jaime Uribarri, Weijing Cai, Susan Goodman, Renata Pyzik, James Post, Fabrizio Grosjean, Mark Woodward, Gary E. Striker

Research output: Contribution to journalArticle

Abstract

Background and objectives Increased inflammation and oxidative stress may be caused by proteins and lipids modified by cytotoxic advanced glycation end products (AGEs) in food. Restricting food containing elevated AGEs improves these risk factors in diabeticCKD. Because diet adherence can be problematic, this study aimed to remove cytotoxic AGEs from food already ingested and to determine whether sevelamer carbonate sequesters cytotoxic AGEs in the gut, preventing their uptake and thereby reducing AGE-induced abnormalities. Design, setting, participants, &measurements This single-center, randomized, 2-month, open-label, intention-totreat, crossover study compared sevelamer carbonate with calcium carbonate treatment in stage 2-4 diabetic CKD. Participants received 2 months of treatment with one drug, had a 1-week washout, and then received the opposite drug for 2 months. Results: Sevelamer carbonate reduced HbA1c, serum methylglyoxal, serum εN-carboxymethyl-lysine, triglycerides, and 8-isoprostanes. Total cholesterol and fibroblast growth factor 23 were reduced by sevelamer carbonate, relative to calcium carbonate. AGE receptor 1 and sirtuin 1 mRNA were increased and PMNC TNFa levels were decreased by sevelamer carbonate, but not calciumcarbonate. Medications and caloric andAGE intake remained unchanged. Sevelamer carbonate reversibly bound AGE-BSA at intestinal, but not stomach, pH. Conclusions: Sevelamer carbonate significantly reducesHbA1c, fibroblast growth factor 23, lipids, andmarkers of inflammation and oxidative stress, and markedly increases antioxidantmarkers, independently of phosphorus in patients with diabetes and early kidney disease. These novel actions of sevelamer carbonate on metabolic and inflammatory abnormalities in type 2 diabetes mellitus may affect progression of early diabetic CKD.

Original languageEnglish (US)
Pages (from-to)934-942
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number6
DOIs
StatePublished - Jun 1 2012
Externally publishedYes

Fingerprint

Advanced Glycosylation End Products
Diabetic Nephropathies
Inflammation
8-epi-prostaglandin F2alpha
Calcium Carbonate
Food
Oxidative Stress
Sirtuin 1
Pyruvaldehyde
Lipids
Sevelamer
Kidney Diseases
Energy Intake
Serum
Pharmaceutical Preparations
Cross-Over Studies
Phosphorus
Type 2 Diabetes Mellitus
Stomach
Triglycerides

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Effects of sevelamer on HbA1c, inflammation, and advanced glycation end products in diabetic kidney disease. / Vlassara, Helen; Uribarri, Jaime; Cai, Weijing; Goodman, Susan; Pyzik, Renata; Post, James; Grosjean, Fabrizio; Woodward, Mark; Striker, Gary E.

In: Clinical Journal of the American Society of Nephrology, Vol. 7, No. 6, 01.06.2012, p. 934-942.

Research output: Contribution to journalArticle

Vlassara, H, Uribarri, J, Cai, W, Goodman, S, Pyzik, R, Post, J, Grosjean, F, Woodward, M & Striker, GE 2012, 'Effects of sevelamer on HbA1c, inflammation, and advanced glycation end products in diabetic kidney disease', Clinical Journal of the American Society of Nephrology, vol. 7, no. 6, pp. 934-942. https://doi.org/10.2215/CJN.12891211
Vlassara, Helen ; Uribarri, Jaime ; Cai, Weijing ; Goodman, Susan ; Pyzik, Renata ; Post, James ; Grosjean, Fabrizio ; Woodward, Mark ; Striker, Gary E. / Effects of sevelamer on HbA1c, inflammation, and advanced glycation end products in diabetic kidney disease. In: Clinical Journal of the American Society of Nephrology. 2012 ; Vol. 7, No. 6. pp. 934-942.
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AU - Post, James

AU - Grosjean, Fabrizio

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AU - Striker, Gary E.

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