Lower gastrointestinal bleeding in a patient receiving sevelamer: Case report

Phosphate binders such as sevelamer are widely used in patients with chronic kidney disease to lower serum phosphate levels. We present a case of a 67-year-old woman with lower gastrointestinal bleeding after 9 days of using sevelamer carbonate (Renvela®). Sigmoidoscopy revealed multiple deep ulcers (diameter 10–15 mm) and mucosal oedema. Histologic examination showed deposition of sevelamer crystals in these rectal ulcers. We hypothesized that the lower gastrointestinal bleeding was caused by deposition of sevelamer crystals. After cessation of sevelamer, gastrointestinal bleeding stopped. Deposition of sevelamer crystals in the gastrointestinal tract is a rare complication of sevelamer therapy. There are only 17 other recorded cases of gastrointestinal deposition of sevelamer crystals. This adverse effect should be considered in all patients taking sevelamer who present with gastrointestinal symptoms, such as gastrointestinal bleeding and abdominal pain. When sevelamer is discontinued, symptoms and mucosal damage appear to revert.

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P1411THE EFFICACY AND SAFETY OF THE SUCROFFERRIC OXYHYDXIDE IN HEMODIALYSIS PATIENTS : RESULTS OF A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1411 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Evgeny Shutov ◽

Galina Kotlyarova ◽

Ksenia Lysenko ◽

Galina Ryabinskaya ◽

Sergey Lashutin

Keyword(s):

Randomized Controlled Trial ◽

Phosphate Binder ◽

Controlled Trial ◽

Transferrin Saturation ◽

Serum Phosphate ◽

Phosphate Binders ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Sevelamer Carbonate ◽

Fgf 23

Abstract Background and Aims The treatment of hyperphosphatemia is the main goal in the treatment of mineral and bone disorders in patients with CKD. However, the results of the correction of hyperphosphatemia remain unsatisfactory. This is due to the absence of effective and safe medicines. In our prospective randomized controlled trial were evaluated the effects of a 16-week treatment with new phosphate binder - sucroferric oxyhydroxide and a sevelamer carbonate (“sevelamer”) on CKD-MBD parameters in patients on hemodialysis with hyperphosphatemia. Method After a 2-4-week washout period from previous phosphate binders, 50 stable patients with hyperphosphatemia (P > 5.5 mg / dl) were randomized at a 1: 1 ratio to receive sucroferric oxyhydroxide (n = 25) or sevelamer (n = 25) for treatment up to 16 weeks. In all patients were evaluated levels of P, Ca, PTH, ferritin, transferrin saturation, Hb, FGF-23, soluble Klotho, CRP - monthly. The dose of both medications was adjusted according to serum phosphate. Results Phosphate binder therapy of sucroferric oxyhydroxide was associated with a significant decrease in serum phosphate from 6.8 ± 1.5 to 5.27 ± 0.99 mg/dl (p <0.01); however, treatment with sevelamer did not decrease in the level of P: 6.32 ± 1.5 vs 6.35 ± 1.9 mgl/dl. The number of tablets was lower in the sucroferric oxyhydroxide group (mean ± SD 2.0 ± 1.5 tablets / day) compared with sevelamer (mean ± SD 6.1 ± 3.2 tablets / day). The average intact fibroblast growth factor-23 (FGF-23), PTH, transferrin saturation and ferritin did not significantly change in both groups. Klotho changed only in patients received sucroferric oxyhydroxide, an increase of 25% (р < 0.05) and we also noted in this group an increase in Hb level from 105.6 ± 15.7 to 111.9 ± 22.3 g/l (p <0.05) by the end of the study, simultaneously level of CRP significantly decreased (P < 0.01) by 50% . During the study, 6 patients in the group with sucroferric oxyhydroxide and 5 in the sevelamer group dropped out due to dyspeptic symptoms. Conclusion Sucroferric oxyhydroxide is a new effective phosphate binder with a comparable safety profile to a sevelamer. Treatment with this drug can significantly increase the level of Hb, and Klotho and reduce level of inflammation.

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Effects of Nicotinamide and Lanthanum Carbonate on Serum Phosphate and Fibroblast Growth Factor-23 in CKD: The COMBINE Trial

Journal of the American Society of Nephrology ◽

10.1681/asn.2018101058 ◽

2019 ◽

Vol 30 (6) ◽

pp. 1096-1108 ◽

Cited By ~ 33

Author(s):

Joachim H. Ix ◽

Tamara Isakova ◽

Brett Larive ◽

Kalani L. Raphael ◽

Dominic S. Raj ◽

...

Keyword(s):

Growth Factor ◽

Fibroblast Growth Factor ◽

Fibroblast Growth Factor 23 ◽

Gastrointestinal Symptoms ◽

Phosphate Transport ◽

Serum Phosphate ◽

Lanthanum Carbonate ◽

Phosphate Binders ◽

Fibroblast Growth ◽

Baseline Serum

BackgroundHigher serum phosphate and fibroblast growth factor-23 (FGF23) levels may be modifiable to prevent cardiovascular disease in CKD. Short-term studies have reported modest efficacy in phosphate and FGF23 reduction with intestinal phosphate binders in CKD.MethodsTo investigate effects of lanthanum carbonate (LC; a phosphate binder) and/or nicotinamide (NAM; an inhibitor of active intestinal phosphate transport) on serum phosphate and FGF23 in stage 3b/4 CKD, we conducted a randomized trial among individuals with eGFR 20–45 ml/min per 1.73 m2 to NAM (750 mg twice daily) plus LC (1000 mg thrice daily), NAM plus LC placebo, LC plus NAM placebo, or double placebo for 12 months. Dual primary end points were change from baseline in serum phosphate and intact FGF23 concentrations.ResultsMean eGFR for the 205 participants was 32ml/min per 1.73 m2. At baseline, serum phosphate was 3.7 mg/dl and median FGF23 was 99 pg/ml (10th, 90th percentiles: 59, 205). Mean rates of change in phosphate increased slightly over 12 months in all groups and did not differ significantly across arms. Similarly, percent changes in FGF23 per 12 months increased for all arms except LC plus placebo, and did not differ significantly across arms. Gastrointestinal symptoms limited adherence. Adverse events rates were similar across arms.ConclusionsLC and/or NAM treatment did not significantly lower serum phosphate or FGF23 in stage 3b/4 CKD over 12 months. Although these agents appeared safe, intestinal symptoms limited adherence. Reducing phosphate and FGF23 in nondialysis CKD will require new approaches.

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Typhoid fever colitis with massive lower gastrointestinal bleeding

International Surgery Journal ◽

10.18203/2349-2902.isj20190412 ◽

2019 ◽

Vol 6 (2) ◽

pp. 601

Author(s):

Yousif Salem ◽

Keith Johnston ◽

Amro Salem

Keyword(s):

Abdominal Pain ◽

Gastrointestinal Bleeding ◽

Typhoid Fever ◽

Ct Scan ◽

Rare Complication ◽

Right Hemicolectomy ◽

Lower Gastrointestinal Bleeding ◽

High Light ◽

Bleeding Per Rectum ◽

Endemic Areas

Authors are presenting the case of a 34year old female, with no known comorbidities, who after recent travel to Pakistan, presented with fever for 1 month and was diagnosed with typhoid fever.During her admission she developed bleeding per rectum and abdominal pain labeled as right-side colitis, confirmed by endoscopy and CT scan, which was managed surgically by extended right hemicolectomy and ileostomy.The aim of this case is to discuss a rare complication of typhoid fever which is lower gastrointestinal bleeding, and high light the importance of considering rare infectious cases if not in endemic areas.

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