{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:14:05Z","timestamp":1747185245368,"version":"3.40.5"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>Sevelamer is a phosphate\u2010binding resin implicated in gastrointestinal (GI) injury. This study aimed to investigate the role of sevelamer in GI injury among chronic kidney disease (CKD) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>The study included 17 CKD patients (cases) with and 18 CKD patients (comparisons) without sevelamer crystals in specimens. All cases were on sevelamer. Six comparison patients were also taking sevelamer, but crystals were absent in tissue sections. The comparison group was thus subclassified into patients who were and were not taking sevelamer. The frequency of underlying disorders was similar between two groups, including hypertension (cases\u2009=\u200982%; comparisons\u2009=\u200978%) and diabetes mellitus (cases\u2009=\u200953%, comparisons\u2009=\u200950%). The most common presentation was GI bleeding (cases\u2009=\u200941%, comparisons\u2009=\u200933%). Predominant histological patterns were also similar, with ulcers (cases\u2009=\u200942%; comparisons\u2009=\u200939%) and acute ischaemia (cases\u2009=\u200935%; comparisons\u2009=\u200928%) being predominant in both cohorts. Of note, sevelamer was present with amyloidosis and cytomegalovirus in one study case each. Two study patients who continued sevelamer had follow\u2010up biopsies; one showed persistent ulceration and the other appeared normal. Crystals were absent in both.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>GI injury in CKD patients in both groups had similar features regardless of presence of sevelamer, suggesting that it adheres to tissue rather than causes injury. The study highlights other histologically identifiable causes of intestinal injury, as well as injuries unassociated with sevelamer in patients undergoing therapy. Therefore, physicians should be cautious in attributing GI injuries to sevelamer to avoid overlooking other causes and unnecessary treatment discontinuation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.15104","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T09:05:57Z","timestamp":1701680757000},"page":"624-632","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Patterns of gastrointestinal injury in patients with chronic kidney disease: Comparison of cases with and without sevelamer crystals"],"prefix":"10.1111","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0630-055X","authenticated-orcid":false,"given":"Hania","family":"Shakeri","sequence":"first","affiliation":[{"name":"Department of Pathology Montefiore Medical Center\/Albert Einstein College of Medicine  Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1121-267X","authenticated-orcid":false,"given":"Nicole C","family":"Panarelli","sequence":"additional","affiliation":[{"name":"Department of Pathology Montefiore Medical Center\/Albert Einstein College of Medicine  Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2022.2044472"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.12891211"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2369-14-222"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfx013"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjab228"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-015-3269-1"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1592\/phco.29.5.554"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3182999d8d"},{"volume-title":"National Kidney Foundation primer on kidney diseases","year":"2022","key":"e_1_2_8_10_1"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1515\/jtim-2017-0019"},{"key":"e_1_2_8_12_1","first-page":"113","article-title":"Diagnostic and therapeutic considerations for obscure gastrointestinal bleeding in patients with chronic kidney disease","volume":"32","author":"Muftah M","year":"2019","journal-title":"Ann. 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