Is Once Daily Renvela Powder Enough?

As dialysis patients know, hyperphosphatemia is a serious concern and a difficult, daily battle. To combat hyperphosphatemia, it takes a careful consideration of dietary intake with every meal or snack.. and the addition of a 'binder'.

The 'binders' are phosphorous binders that work in the GI tract to trap dietary phosphorous and help to rid the body of the phosphorous the kidneys are otherwise unable to eliminate in the urine. In addition to the annoyance of needing to be mindful of everything you eat, the pill burden of these binders is often tremendous. It is not uncommon for a hemodialysis patient to take anywhere between 3-5 pills with each meal in an effort to control serum phosphorous to goal < 5.0-5.5.

Accordingly, anything that can decrease the pill burden will be welcomed. Fosrenol has had some degree of success with a chewable tablet taken with each meal. Renvela has followed with an unconventional delivery method of its own, a powder form. The powder comes in the strength of 2.4 grams per packet. This is equivalent to three Renvela pills (800 mg each).

A randomized study conducted at local Winthrop Hospital by Dr Fishbane et al was recently published in the American Journal of Kidney Diseases. After a 2-week phosphate-binder washout, patients were randomly assigned to once-daily sevelamer carbonate powder or thrice-daily sevelamer hydrochloride tablets.

Conclusions

Once-daily administration of sevelamer carbonate powder was not as effective in decreasing serum phosphorus levels as thrice-daily administration of sevelamer hydrochloride tablets. Nevertheless, once-daily sevelamer carbonate powder decreased serum phosphorus levels significantly, reaching the KDOQI phosphorus target in most patients. Therefore, once-daily dosing of sevelamer carbonate may be a reasonable alternative.