Objective To investigate the efficacy of sevelamer (SL) and calcium acetate (CA) in treating hyperphosphatemia in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD) and their effects on calcium-phosphorus metabolism and levels of peripheral blood fetuin-A and fibroblast growth factor-23 (FGF-23).

Methods A total of 92 ESRD patients attending the First Hospital of Zibo between January 2022 and December 2023 were enrolled. They were randomly assigned to either the CA group (46 cases) or the SL group (46 cases) using a random number table method. Patients in both groups received MHD and conventional treatment. Additionally, patients in the CA group were given CA, while those in the SL group were given SL, with the treatment continuing for 3 months. The outcome indicators were assessed and compared between the two groups. The primary outcome indicator was clinical efficacy. The secondary outcome indicators included calcium-phosphorus metabolism indicators (blood calcium, blood phosphorus, calcium-phosphorus product, and intact parathyroid hormone iPTH), coronary artery calcification score (CACs), serum biochemical indicators (including fetuin-A, FGF-23, and C-reactive protein CRP), and adverse reactions and cardiovascular events during the course of treatment.

Results There were no statistically significant differences in baseline data between the two groups (P > 0.05). There was a significant difference in clinical efficacy between the SL group and the CA group (P < 0.05). The differences in blood calcium, blood phosphorus, calcium-phosphorus product, iPTH, and CACs before and after treatment were statistically significant between the two groups (P < 0.05). The differences in fetuin-A, FGF-23, and CRP before and after treatment were also statistically significant between the two groups (P < 0.05). During treatment, there was no significant difference in the incidences of adverse reactions and cardiovascular events between the two groups (P > 0.05).

Conclusion SL demonstrates superior efficacy compared to CA in treating hyperphosphatemia in MHD patients. SL effectively regulates calcium-phosphorus metabolism, reduces CACs, regulates peripheral blood fetuin-A and FGF-23 levels, and leads to fewer adverse reactions. SL may be a preferred option for clinical management.