A case report of sevelamer-associated recto-sigmoid ulcers

Optimal phosphorous control is an important aspect of the care of patients with end-stage renal disease, and phosphate binders are usually needed. A 74-year-old woman with end-stage renal disease on maintenance hemodialysis presented to the emergency room with abdominal discomfort, rectal pain, and...

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Bibliographic Details
Published in:BMC gastroenterology 2016-02, Vol.16 (21), p.20, Article 20
Main Authors: Tieu, Christina, Moreira, Roger K, Song, Louis M Wong Kee, Majumder, Shounak, Papadakis, Konstantinos A, Hogan, Marie C
Format: Article
Language:English
Subjects:
Aged
Care and treatment
Case Report
Chelating Agents - adverse effects
Colon, Sigmoid - drug effects
Female
Gastroenterology
Health aspects
Humans
Influence
Kidney Failure, Chronic - drug therapy
Phosphorus imbalance
Proctocolitis - chemically induced
Rectum - drug effects
Renal Dialysis
Risk factors
Sevelamer - adverse effects
Sevelamer carbonate
Ulcer - chemically induced
Ulcers
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Summary:Optimal phosphorous control is an important aspect of the care of patients with end-stage renal disease, and phosphate binders are usually needed. A 74-year-old woman with end-stage renal disease on maintenance hemodialysis presented to the emergency room with abdominal discomfort, rectal pain, and blood-tinged stools. Initial concern was for a rectal carcinoma, based on the symptoms and imaging in initial computerized tomography of the abdomen showing rectal wall thickening, and her clinical presentation. She had been treated with the phosphate binder sevelamer for two months. In this case report, we explore the unique features of sevelamer-associated recto-sigmoid ulcers which led to her symptoms. Sevelamer is widely used in chronic kidney disease and end-stage renal disease patients with hyperphosphatemia. It is a crosslinked polymeric amine that binds phosphates and bile acids; it is not systemically absorbed. To the authors' knowledge, this is the first reported case of recto-sigmoid ulcers associated with use of this phosphate binder. Nephrologists, pathologists, and gastroenterology sub-specialists should be aware of this recently-reported entity in patients on sevelamer with suggestive symptoms, as this medication is widely used in renal patients.
ISSN:1471-230X
1471-230X
DOI:10.1186/s12876-016-0441-4