| Theme | Revival of renal osteodystrophy -- new treatment targeting bone | |
|---|---|---|
| Title | Non-absorbable amine functional polymer : Bixalomer | |
| Publish Date | 2016/12 | |
| Author | Kei Asakura | Division of Nephrology, Kawasaki Saiwai Hospital |
| Author | Goh Takahashi | Division of Nephrology, Kawasaki Saiwai Hospital |
| Author | Maki Shibata | Division of Nephrology, Kawasaki Saiwai Hospital |
| Author | Susumu Uda | Division of Nephrology, Kawasaki Saiwai Hospital |
| Author | Daisuke Sanada | Division of Nephrology, Department of Medicine, Showa University School of Medicine |
| Author | Tadao Akizawa | Division of Nephrology, Department of Medicine, Showa University School of Medicine |
| [ Summary ] | Bixalomer, a non-absorbable amine functional polymer, was launched in 2012, and is only available in Japan. It reduces serum phosphate (P) levels by binding phosphorus in the gastrointestinal tract and inhibiting its absorption. Being a non-calcium, metal-free phosphate binder like sevelamer hydrochloride bixalomer does not cause calcium overload or metal accumulation in tissues. Sevelamer hydrochloride frequently causes gastrointestinal adverse events, such as abdominal distension and constipation. Bixalomer is expected to cause fewer gastrointestinal side effects as it expands less in the gastrointestinal tract than sevelamer hydrochloride does. A phase III trial of hemodialysis patients showed non-inferiority of bixalomer over sevelamer hydrochloride for the reduction of P level, and the incidence of adverse events was lower in the bixalomer group. Bixalomer has also been approved for the treatment of hyperphosphatemia in CKD patients not on dialysis. Bixalomer reduces not only serum P but also the levels of lipids, FGF-23, and some uremic substances like indoxyl sulfate, while preserving serum hydrogen carbonate. These findings suggest many clinical effects beyond P reduction for widespread use of bixalomer. | |