Sevelamer is a phosphate binder commonly used in patients with end-stage renal disease that has been linked to severe gastrointestinal inflammation and perforation[1]. This case series identified 12 patients with biopsy-proven sevelamer-induced gastrointestinal disease over 5 years at a large urban hospital[1].
Key findings:
- Patients presented with a broad range of symptoms including diarrhea, abdominal pain, melena, and hematochezia[1]
- Endoscopic/surgical findings included ulcerations, mucosal inflammation, pseudomembranous colitis, transmural necrosis, and perforation throughout the GI tract[1]
- Several patients had preexisting conditions associated with decreased GI motility (e.g. chronic constipation, diabetes, opioid use) and/or impaired mucosal integrity (e.g. diabetes, heart failure, cirrhosis)[1]
- Time from sevelamer initiation to diagnosis ranged from 29 to 3,249 days (median 471 days)[1]
- 11 of 12 patients clinically improved after stopping sevelamer, with the remaining patient passing away shortly after diagnosis[1]
The authors conclude that sevelamer-induced gastrointestinal disease has a broad range of presentations and severity[1]. Clinicians should be aware of this increasingly recognized condition, particularly in patients with risk factors like impaired GI motility or mucosal integrity[1]. More research is needed on the time course of disease development and resolution after stopping the drug[1].
Citations:
[1] https://journals.lww.com/ctg/fulltext/2024/03000/sevelamer_induced_gastrointestinal_disease_in_12.8.aspx#:~:text=ARTICLE%3A%20COLONSevelamer-Induce