Abstract Background: The significant incremental expense in the use of conventional sevelamer dose prompted us to evaluate the role of prescribing a lower dose of sevelamer. Methods: To determine the optimum strategy for prescribing sevelamer in peritoneal dialysis patients, we conducted an open-label randomized study comparing the treatto- goal strategy (4. 0-g daily sevelamer dose) with lower sevelamer dose (1. 2-g daily dose). Results: Twenty-seven peritoneal dialysis patients with serum calcium × phosphorus product above 55 mg2/dL2 were recruited. Eighteen were randomized to the lowdose treatment group (1. 2 g daily), and 9 to the treat-togoal (4. 0 g daily) group. Overall, significantly lower calcium × phosphorus product and serum phosphorus levels at 6 months were achieved by the treat-to-goal treatment. The proportions of patients who attained the Kidney Disease Outcomes Quality Initiative (K/DOQI) treatment target, however, did not differ significantly between the treat-togoal and low-dose treatment groups (66. 7% ± 30. 8% vs. 33. 3% ± 21. 8%, p=0. 10). The numbers needed to treat to benefit 1 patient who attains the K/DOQI recommendation are 1. 5 patients (95% confidence interval 95% CI, 1. 0-2. 8) in the 4. 0-g daily dose and 3 patients (95% CI, 1. 8-8. 7) in the 1. 2-g daily dose group. Therefore, an extra 66. 7% of subjects would be able to attain the treatment recommendation within the same budget if the daily dose of sevelamer used was 1. 2 g instead of the usual 4. 0 g. Compared with a 1. 2-g daily dose of sevelamer, the 4. 0-g daily dose had an incremental cost-effectiveness ratio (ICER) of US 2, 353 per additional patient achieving the K/DOQI target. Multivariate analysis showed that only the calcium × phosphorus product after 1 month of sevelamer treatment was predictive of treatment response. Conclusions: Low-dose sevelamer treatment might be a cost-effective approach, which is “good for many rather than best for a few. ”
Chow et al. (Thu,) studied this question.