Renvela® (sevelamer carbonate) is indicated for the control of serum phosphorus in patients with Chronic Kidney Disease (CKD) on dialysis. Renvela contains sevelamer carbonate, a non-absorbed phosphate binding crosslinked polymer, free of metal and calcium. It contains multiple amines separated by one carbon from the polymer backbone. These amines exist in a protonated form in the intestine and interact with phosphate molecules through ionic and hydrogen bonding. By binding phosphate in the dietary tract and decreasing absorption, sevelamer carbonate lowers the phosphate concentration in the serum.
Renvela has the same polymeric structure as Renagel® (sevelamer hydrochloride)1 with a salt change.
Treatment with Renvela improves serum bicarbonate levels compared to Renagel.2
Renvela contains no calcium or metal1 and does not accumulate in the body, either in plasma or tissues.
Calcium-based binders have been associated with calcification, even at doses below the KDOQI-recommended maximum.3,4,5,6
Hypercalcemia has been found to be prevalent in 50% of dialysis patients (serum calcium >9.5 mg/dL).7
Lanthanum has been shown in human studies to accumulate in bone and in animal studies to accumulate in the GI tract, liver and other tissues.8
Aluminum-containing agents have been associated with acute aluminum neurotoxicity, dialysis encephalopathy, aluminum bone disease, microcytic anemia and other complications.3
2. Delmez J, Block G, Robertson J, et al. A randomized, double-blind, cross-over design study of sevelamer hydrochloride and sevelamer carbonate in patients on hemodialysis. Clin Nephrol. 2007;68(6):386-391.
3. National Kidney foundation. KDOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(suppl 3):S1-S201
4. Chertow GM, Burke SK, Raggi P. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002;62:245-252
5. Block GA, Spiegel DM, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int. 2005;68(4):1815-1824
6. Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. New Eng J Med. 2000;342:1478-1483
7. Young EW, Albert JM, Satayathum S, et al. Predictors and consequences of altered mineral metabolism: The Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2005;67:1179-1187
Renvela® (sevelamer carbonate) is indicated for the control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis
Renvela is contraindicated in patients with bowel obstruction
Caution should be exercised in patients with dysphagia, swallowing disorders, severe gastrointestinal (GI) motility disorders including severe constipation, or major GI tract surgery
Uncommon cases of bowel obstruction and perforation have been reported
Serum bicarbonate and chloride levels should be monitored
Vitamins D, E, K (coagulation parameters), and folic acid levels should be monitored
The most frequently occurring adverse reactions in a short-term study with sevelamer carbonate tablets were nausea and vomiting
In a short-term study of sevelamer carbonate powder dosed three times daily, adverse events were similar to those reported for sevelamer carbonate tablets
In long-term studies with sevelamer hydrochloride, which contains the same active moiety as sevelamer carbonate, the most common adverse events included: vomiting, nausea, diarrhea, dyspepsia, abdominal pain, flatulence, and constipation
Cases of fecal impaction and, less commonly, ileus, bowel obstruction, and bowel perforation have been reported
Drug-drug interactions may occur with some medications and should be taken into consideration when instructing patients how to take Renvela
Patients should be informed to take Renvela with meals and to adhere to their prescribed diets.
Renagel® (sevelamer hydrochloride) is indicated for the control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis
Renagel is contraindicated in patients with hypophosphatemia or bowel obstruction
Caution should be exercised in patients with dysphagia, swallowing disorders, severe gastrointestinal (GI) motility disorders including severe constipation or major GI tract surgery
Common adverse events reported with Renagel include vomiting, nausea, diarrhea, dyspepsia, abdominal pain, and constipation
Other events reported include pruritus, rash, fecal impaction, and intestinal obstruction
Drug-drug interactions may occur with some medications and should be taken into consideration when instructing patients how to take Renagel
Patients should be informed to take Renagel with meals and to adhere to their prescribed diets
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