Sevelamer carbonate is an
anion exchange
pharmaceutical, developed to improve on the performance of the non-absorbable, non-
calcium, and
metal-free
phosphate binder
sevelamer hydrochloride.
Sevelamer carbonate is expected not to worsen
metabolic acidosis, as previously reported during long-term treatment with
sevelamer hydrochloride in
hemodialysis (HD) patients.
Carbonate is the alternate counterion to
chloride on the
sevelamer polymeric backbone, but the active poly(
allylamine) responsible for
phosphate (PO₄) binding remains unaltered. Therefore,
sevelamer carbonate is expected to reduce elevated serum
phosphorus level, similarly to
sevelamer hydrochloride. Sevelamers are prescribed in uremic HD patients to control
hyperphosphatemia, but the
carbonate has also been proposed for the treatment of
chronic kidney disease (CKD) non-dialysis patients. Although
hyperphosphatemia is regarded as a main contributor to increased mortality in the HD population because of cardiovascular calcification,
metabolic acidosis has also been advocated as a major player in the increased mortality in this population, by engendering
malnutrition, negative
nitrogen balance, and
inflammation. This paper reviews the evidence showing that
sevelamer carbonate is as good as
sevelamer hydrochloride in terms of
hyperphosphatemia control in CKD, but with a better outcome in serum
bicarbonate balance.