低钙透析液对血液透析伴继发性甲状旁腺功能减退患者的临床研究

目的：探讨应用含钙1.25mmol／L浓度透析液进行血液透析对维持性血液透析（MHD）伴相继发性甲状旁腺功能减退患者的钙磷代谢和甲状旁腺功能的影响。方法：选择MHD6个月以上、病情稳定、连续2次血iPTH〈100pg／ml的患者60例,随机分为对照组（含钙1.5mmol／L透析液）和治疗组（含钙1.25mmol／L透析液）,每组各30例,观察时间6个月。观察并记录研究前、研究后l、3、6个月等不同时期患者血iPTH、血清校正钙、磷、钙磷乘积等指标的变化以及相关不良反应。另外,选择使用含钙浓度1.5mmol／L和1.25mmol／L透析液进行MHD的患者各20例,检测单次透析前、透析结束时以及下次透析前的血清校正钙、磷和iPTH浓度。结果：（1）治疗组单次透析后血清校正钙、磷和钙磷乘积均较透析前明显下降,iPTH浓度较透前明显升高,P〈0.01;而对照组上述血钙和iPTH浓度无明显变化;（2）透析后治疗组血清校正钙和钙磷乘积较对照组明显下降,血iPTH浓度较对照组明显升高,P〈0.01;两组血磷浓度差异无统计学意义。（3）治疗组1个月后血清校正钙、磷和钙磷乘积较治疗前开始下降,3个月后进一步下降,P〈0.05,6个月后各项指标趋于稳定;iPTH水平1个月后较治疗前明显升高,并随着治疗时间的延长,逐渐升高,P〈0.01。（4）对照组治疗后1、3、6个月上述指标与治疗前比较差异无统计学意义。（5）两组透析过程中出现的不良反应差异无统计学意义。结论：对于血iPTH〈100pg／ml MHD患者应用含钙1.25mmol／L透析液进行血液透析能较好地控制其血清校正钙、磷、钙磷乘积水平,有效地改善被过度抑制的甲状旁腺功能,并且安全性良好。     

慢性肾功能衰竭继发甲状旁腺功能亢进外科治疗临床分析

背景与目的：继发性甲状旁腺功能亢进（SHPT）是慢性肾功能衰竭患者常见的并发症之一。本研究总结43例慢性肾功能衰竭继发性甲状旁腺功能亢进患者行甲状旁腺全切加自体前臂移植术的临床经验,旨在探讨如何改善患者机体的钙磷代谢紊乱, 缓解患者骨痛、皮肤瘙痒及肌无力等症状,改善患者生活质量。 方法：回顾性分析2017年1月—2018年12月在湘南学院附属医院乳腺甲状腺外科接受甲状旁腺全切加自体前臂移植术的43例继发性甲状旁腺功能亢进患者临床资料,比较手术前后临床症状（骨关节痛、皮肤瘙痒、乏力）和血液化验结果（甲状旁腺激素、血钙、血磷、碱性磷酸酶）的变化。 结果：43例患者骨关节痛、皮肤瘙痒、乏力临床症状在术后第1天明显缓解,在术后1个月上述症状消失。术后10 min、第1、7天和第1、3、12个月的甲状旁腺激素水平分别为（279.23±186.51）、（81.62±51.46）、（21.09±14.36） pg/mL和（27.35±12.04）、（33.27±11.08）、（372.65±15.72） pg/mL,均显著低于术前的（2 436.71±825.13） pg/mL（均P<0.05）;术后第1、7天和第1、3、12个月的血钙水平分别为（1.91±0.32）、（1.75±0.35） mmol/L和（1.84±0.29）、（2.04±0.27）、（2.13±0.30）mmol/L均显著低于术前的（2.58±0.31）mmol/L（均P<0.05）;术后第1、7天和第1、3、12个月的血磷水平分别为（1.61±0.50）、（1.18±0.47） mmol/L和（0.99±0.41）、（0.95±0.34）、（1.20±0.35）mmol/L均显著低于术前的（2.17±0.58）mmol/L（均P<0.05）;血碱性磷酸酶水平在术后1、7 d分别为（580.19±223.56）、（678.52±239.43）U/L高于术前（468.43±214.95）U/L,而在术后1、3、12个月分别为（513.62±227.32）、（431.62±215.76）、（316.24±265.15） U/L均低于术前（均P<0.05）。 结论：对具备手术指征的继发性甲状旁腺功能亢进患者,甲状旁腺全切加自体前臂移植术是一种安全、有效的治疗方法,术后积极补钙可减少低钙血症的发生。     

认知护理干预对血液透析患者钙磷水平的效果研究

目的：探讨认知护理干预对维持性血液透析（ MHD）患者对磷代谢知晓度及钙磷水平的影响。方法：对222例MHD患者进行问卷调查,给予护理认知干预护理6个月后,比较干预前后患者对磷代谢相关知识的知晓度及血磷水平差异。结果：222例MHD患者护理干预前后认知得分≥40的例数分别为146例（65.77%）和195例（87.83%）、知道血磷正常值的例数分别是135例（60.80%）和193例（86.93%）；不知道含磷高的食物的例数分别是128例（57.65%）和13例（5.80%）、知道控制血磷升高主要方法分别是151例（68.02%）和198例（89.01%）。前后比较,差异有统计学意义（χ2值分别为29.126,39.26,137.44,29.58；P〈0.000）。采取认知护理干预6个月后,观察222例MHD患者钙磷代谢指标均比干预前有改善[血磷（1.96±0.70）/（2.04±0.59）mmol/L、钙（2.42±0.28）/（2.30±0.28）mmol/L、钙磷乘积（58.31±14.90）/（59.86±18.29）、IPTH（489.63±30.04）/（557.22±37.39） pg/ml]差异均有统计学意义（ t值分别为1.5.5,-6.47,1.41,2.96；P〈0.000）。结论：认知护理干预可以提高维持性血液透析患者对磷代谢相关知识的认知度,有助于降低血磷水平及IPTH。     

低钙透析液对腹膜透析患者钙磷代谢的影响

目的横断面研究腹膜透析患者使用低钙透析液的安全性及其影响因素。方法选择西安交通大学医学院第一附属医院肾脏内科腹膜透析超过6个月的患者共39例，其中男24例，女15例，年龄56．49±19．31岁，其中使用常规（ca 1．75mmol／L）透析液8例，低钙（ca 1．25mmol／L）透析液31例，比较两组血清钙、磷、甲状旁腺激素、血压以及使用碳酸钙的情况。结果两组血钙无明显差异；常规透析液组血磷和钙磷乘积高于低钙组，两组iPTH无明显差异。低钙组服用碳酸钙剂量明显高于常规透析液组。低钙组服用碳酸钙与未服用碳酸钙血钙无明显差异，服用碳酸钙组血磷控制较为理想、钙磷乘积更接近正常，未服用碳酸钙组血PTH明显升高。结论腹膜透析患者使用低钙透析液有利于控制血磷和血压，有效预防钙磷乘积升高。提高对碳酸钙的依从性是预防使用低钙透析液后引起继发性甲状旁腺功能亢进的关键。     

维持性血液透析患者矿物质代谢研究

目的 探讨新乡地区维持性血液透析（MHD）患者矿物质代谢现况及相关影响因素,以提高本地区MHD患者生存质量.方法 收集2012年1月至2013年8月新乡地区4家综合性医院466例MHD3个月以上患者的临床资料.检测血清钙离子、磷、全段甲状旁腺激素（iPTH）及碱性磷酸酶（ALP）水平.分析MHD患者矿物质代谢现况及其与年龄、透析龄、营养不良、透析充分性的关系.结果 466例患者血钙平均值为（1.95±0.34） mmol/L,血磷平均值为（2.54± 1.38）mmol/L,iPTH平均值为（409±346）ng/L;钙、磷、iPTH达标率分别为34.3％（160/466）、20.4％（95/466）和25.5％ （119/466）.年龄≥60岁组（n=159）患者的血磷[（2.27±0.95）mmol/L比（2.68± 1.54） mmol/L]、iPTH[（344±235） ng/L比（437±383）ng/L]、ALP值[（49.0±36.4）mmol/L比（77.1±78.5） mmol/L]均低于年龄＜60岁组（n=307）（P均＜0.01）.iPTH＞ 300ng/L组（n=242）的血磷、ALP、透析龄明显高于iPTH≤300 ng/L组（n=224）（均P＜0.01）.透析龄≥24个月组（n=228）患者的血磷[（2.70±1.49） mmol/L比（2.35±1.20） mmol/L]、血钙[（1.88±0.35） mmol/L比（2.03±0.31） mmol/L]、iPTH[（493±384） ng/L比（301±249） ng/L]、ALP值[（74.3±73.3） mmol/L比（52.0±51.0）mmol/L]与透析龄＜24个月组（n=238）比较差异均有统计学意义（均P＜0.05）.结论 该地区MHD患者存在着明显的矿物质代谢紊乱及甲状旁腺机能亢进症,透析龄长的患者及年轻透析患者高磷血症、低钙血症更为突出.     

低钙透析液对血液透析患者生活质量的影响

目的探讨低钙透析液（LCD）对维持性血液透析（MHD）患者生活质量（OOL）的影响。方法将30例血清矫正钙≥2．37mmol／L的MHD患者依据血甲状旁腺激素（iPTH）水平分为3组,均使用LCD透析3个月,比较3组患者使用LCD透析前后SF-36问卷评分值及血清钙、磷、钙磷乘积、iFrrH、骨钙素（BGP）水平。结果①透析后与透析前相比,Ⅰ组患者SF-36总分、生理健康总分（PCS）、生理功能、躯体职能（RP）、躯体疼痛（BP）及情感状况评分增高（P〈0．05）,总体健康、生命活力、社会功能及精神健康无差异;Ⅱ组患者PCS、RP和BP评分降低（P〈0．05）,余指标无差异;Ⅲ组各指标评分均无差异（P〉0．05）。②与透析前相比,Ⅰ、Ⅱ组患者透析后血清钙和钙磷乘积均降低（P〈0．05）,iPTH和BGP水平均升高（P〈0．05）;Ⅲ组无变化。结论LCD短期应用能显著提高无动力型骨病患者生活质量,尤其减轻躯体疼痛,长期使用可能影响患者生理健康从而对QOL产生负影响,LCD对MHD患者心理健康无明显改善。     

铝碳酸镁治疗血透患者高磷血症的研究

目的:评估短期使用铝碳酸镁片(达喜)治疗维持性血液透析患者高磷血症的疗效及安全性。方法:选取2013年10月~2015年9月在我院维持性血液透析(3个月)的慢性肾衰竭伴高磷血症(血磷2.26 mmol/L)的患者31例。给予铝碳酸镁片(达喜)每天3次,每次2片(1.0 g),进餐时嚼服,疗程2~4周。比较治疗前后患者血钙、血磷、血镁、钙磷乘积等的变化,并监测不良反应。结果:31例患者中26例完成研究并有完整资料,其中男22例,女4例,9例合并糖尿病。26例患者年龄28岁~78岁,平均58.0岁,透析龄3~102月,平均39.6月。平均每周透析时间10.13 h,平均KT/V=1.36。治疗期间使用的透析液离子浓度为:钙1.50 mmol/L,镁0.50 mmol/L,钾2.0 mmol/L。治疗前生化指标:校正血钙2.34 mmol/L,血磷3.21 mmol/L,血镁1.21 mmol/L,钙磷乘积89.41,血清白蛋白40.6 g/L,血PTH 423.4 pg/ml。铝碳酸镁平均治疗3周后复查校正血钙、血磷、血镁、钙磷乘积值分别为:2.40 mmol/L、1.95 mmol/L、1.46 mmol/L、53.54。与治疗前相比,降幅分别为:-2.25%、39.26%、-20.26%、40.12%。治疗后11例(42.3%)患者血磷达标(1.78 mmol/L)。治疗过程中有1例(3.8%)出现腹胀,1例(3.8%)出现恶心,但均能耐受。结论:血透患者短期使用(不超过4周)铝碳酸镁能有效降低血磷及钙磷乘积,可使血磷降低39.3%,钙磷乘积降低40.1%,而且零钙负荷。铝碳酸镁治疗后血钙轻微升高,差异无统计学意义。铝碳酸镁治疗后血镁有明显升高。铝碳酸镁使用后除了轻微胃肠道反应外,无其他不良反应。短期使用铝碳酸镁片(达喜)治疗血透患者高磷血症是安全、有效的。     

低钙透析联合高通量透析对钙磷代谢及营养状态的影响

目的观察低钙透析液联合高通量透析（HFHD）对尿毒症伴矿物质及骨代谢异常患者钙磷代谢及营养状态的影响。方法选择2009年1月至2009年12月我院维持性血液透析（MHD）患者23例,所有患者血钙处于正常高值或高钙血症或高钙磷乘积且血清全段甲状旁腺素（iPTH）水平升高,观察前所有患者使用钙离子浓度为1．5mmol／L的透析液和FreseniusF6透析器。将23例患者随机分为2组。A组12例,换用FreseniusF60高通量透析器;B组11例,继续使用FreseniusF6透析器。所有患者均换用钙离子浓度为1．25mmol／L的透析液,共观察12周。比较2组血钙、血磷、钙磷乘积、iPTH、血红蛋白（Hb）、血浆白蛋白（Alb）、前白蛋白（PAB）、超敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、肱三头肌皮皱厚度（TSF）和上臂中段肌肉周径（MAMC）。结果与观察前相比,A组观察后血钙、血磷、钙磷乘积、iPTH降低（P〈0．01）,Hb、Alb、PAB升高（P〈0．05）,hsCRP、IL-6、TNF-α降低（P〈0．01）,TSF升高（P〈0．01）,MAMC有升高趋势,但差异尚无统计学意义（P〉0．05）;B组血钙降低（P〈0．01）,其余各项指标无差异（P〉0．05）。观察后,A组血钙、钙磷乘积、iPTH低于B组（P〈0．01）,血磷及IL-6亦低于B组（P〈0．05）。无一例患者出现低血压及肌肉痉挛。结论低钙透析液联合HFHD可改善尿毒症伴矿物质及骨代谢异常患者钙磷代谢及营养状态。     

腹膜透析患者红细胞生成素低反应的影响因素及其预测价值

目的 分析影响腹膜透析患者红细胞生成素（EPO）治疗反应的因素，并建立回归模型。 方法 114例腹膜透析患者根据每周EPO剂量分为低反应组、正常反应组和高反应组。收集患者临床资料，检测营养及炎性反应指标，进行直线相关和Ordinal等级回归分析。 结果 与高反应组及正常反应组比较， EPO低反应组血红蛋白[（78.11±13.42）比（106.28±23.83）、（96.31±12.33） g/L]、血清白蛋白[（33.98±4.78）比（39.72±4.26）、（35.76±4.88） g/L]水平下降，C反应蛋白（CRP）[（26.08±21.66） 比（5.46±1.75）、（11.82±5.63） mg/L]、血清铁蛋白[（371.08±89.38）比（289.39±76.84）、（323.07±62.46） μg/L]水平升高，差异均有统计学意义 (均P < 0.01)。相关回归分析显示，CRP、血清白蛋白及铁蛋白是EPO治疗反应的显著影响因素(P < 0.05)。根据这些因素建立数学模型，血清白蛋白<30 g/L对EPO治疗低反应的影响最大，高血清铁蛋白、高CRP的影响次之。 结论 血清白蛋白、CRP和铁蛋白水平与EPO治疗反应相关。炎性反应状态和营养不良是导致EPO低反应的主要原因。     

维持性血液透析患者主动脉钙化相关影响因素分析

目的：探讨维持性血液透析（MHD）患者主动脉钙化的相关影响因素。方法：采用胸部正位X线成像技术检测183例MHD患者主动脉钙化情况,将入选患者分为主动脉钙化组（A组）和主动脉无钙化组（B组）,透析前抽血检测血钙、血磷、全段甲状旁腺激素（iPTH）、C反应蛋白（CRP）和血清白蛋白（Alb）等指标,并计算钙磷乘积,比较两组年龄、透析龄和血清学指标的差异,将上述指标与主动脉钙化进行相关性分析,并对筛选出来的危险因素进行非条件Logistic回归分析。结果：A组和B组在年龄、透析龄、血磷、钙磷乘积和CRP水平方面,差异均有统计学意义（P〈0.01或P〈0.05）;MHD患者主动脉钙化的相关影响因素包括：年龄、透析龄、血磷、钙磷乘积及CRP;Logistic回归分析表明,年龄、透析龄和血磷是主动脉钙化的独立危险因素（P〈0.01）。结论：MHD患者主动脉钙化相当常见,主动脉钙化与年龄、透析龄、钙磷代谢和炎症状态有关。     

腹膜透析相关性葡萄球菌腹膜炎的临床特征

目的 回顾性分析中山大学附属第一医院腹膜透析中心2006年1月至2010年12月腹膜透析相关性葡萄球菌腹膜炎的临床特征,为临床诊治提供依据.方法 选取近5年我院葡萄球菌腹膜炎的持续性不卧床腹膜透析(CAPD)患者,作为研究对象,归为腹膜炎组;同时,选取相应的未发生腹膜炎的CAPD患者,作为一对一配对观察目标,归为对照组.探讨葡萄球菌腹膜炎的易感因素、菌群分布、耐药性和预后.结果 腹膜炎组和对照组各纳入74例患者,两组患者基线资料差异无统计学意义.腹膜炎组患者Kt/V低于对照组(1.74±0.03比2.61±0.48,P＜0.01),腹膜炎组营养学指标、血红蛋白[(91.70±25.43) g/L比(111.50±19.59) g/L,P＜0.01]、钾[(3.43±0.70)mmol/L比(3.78±0.73) mmol/L,P=0.002]、钠[(137.09±5.06)mmol/L比(140.57±3.55)mmol/L,P＜0.01]、氯[(98.31±6.14) mmol/L比(101.52±4.58) mmol/L,P=0.001]、钙[(2.23±0.24) mmol/L比(2.31±0.22) mmol/L,P=0.04]水平均明显低于对照组.葡萄球菌腹膜炎5年总体发病率为0.030例/腹透年,表皮葡萄球菌为主要菌种,其次是金黄色葡萄球菌.各类葡萄球菌对万古霉素、替考拉宁、利奈唑胺均敏感.葡萄球菌腹膜炎近5年总体治愈率为89.19％,病死率为4.05％;表皮葡萄球菌复发率高于其他菌种,为40％.结论 营养差、透析不充分、随诊周期长、贫血、电解质失衡是葡萄球菌腹膜炎的易感因素.我院葡萄球菌腹膜炎在近5年总体发病率、病死率较前下降低,表皮葡萄球菌复发率高,需加强防治.     

A comparison of sevelamer hydrochloride with calcium acetate on biomarkers of bone turnover in hemodialysis patients

OBJECTIVE: To evaluate the influence of sevelamer hydrochloride and calcium acetate on biomarkers of bone turnover in patients with hyperphosphatemia receiving hemodialysis. METHODS: In this prospective, open-label, randomized, active-controlled study, 70 patients (38 men and 32 women) with hyperphosphatemia (serum phosphorus level >6.0 mg/dL) underwent a two-week washout period and were randomly selected to receive sevelamer hydrochloride (n = 37) or calcium acetate (n = 33) for eight weeks. Changes in serum levels of intact parathyroid hormone (iPTH), alkaline phosphatase (Alk-P), phosphorus, and calcium were measured and compared. RESULTS: After eight weeks of treatment, calcium acetate lowered iPTH levels significantly more than sevelamer hydrochloride did (-178.0 vs. -69.0 pg/mL, p = 0.0019). Levels of Alk-P were significantly elevated in patients given sevelamer hydrochloride compared with levels in those given calcium acetate treatment (24.09 vs. 7.45 U/L, p = 0.0014). Changes in serum phosphorus levels did not differ between sevelamer hydrochloride (-1.93 mg/dL) and calcium acetate (-2.5 mg/dL) at the end of the study (p = 0.0514). Changes in the calcium and phosphorous product did not significantly differ between the sevelamer-hydrochloride group (-18.06 mg2/dL2) and the calcium-acetate group (-19.05 mg2/dL2, p = 0.6764). Fifteen patients (45.5%) treated with calcium acetate had hypercalcemia (serum-adjusted calcium level >10.5 mg/dL); the rate was significantly higher than that of patients treated with sevelamer (five [13.5%] of 37, p = 0.0039). CONCLUSION: Treatment with sevelamer hydrochloride had the advantage of maintaining stable iPTH levels and elevating Alk-P levels while lowering serum phosphorus levels and calcium-phosphorous product.     

Long-term comparison of sevelamer hydrochloride to calcium-containing phosphate binders

AIM: In patients with end-stage renal disease (ESRD), hyperphosphataemia and an elevated calcium-phosphorus (Ca-P) product contribute to morbidity and mortality. Suggested target goals for serum phosphorus concentration and calcium-phosphorus product have recently been lowered. As a result, long-term comparative studies of the efficacy of phosphate binders are critical. This study compares the long-term efficacy of sevelamer hydrochloride to calcium-containing binders (CCB). METHODS: A retrospective chart review was conducted in 30 patients receiving sevelamer hydrochloride for >1 years and 25 patients receiving CCB. RESULTS: Patients on sevelamer hydrochloride had lower serum bicarbonate concentration than those on CCB, 18.6 +/- 2.7 versus 20.3 +/- 1.8 mmol/L (P = 0.0017). Serum phosphorus concentration was higher in patients on sevelamer hydrochloride compared to CCB 2.10 +/- 0.87 versus 1.74 +/- 0.28 mmol/L (P = 0.0013), as was the Ca-P product 4.97 +/- 0.94 mmol2L2 (62.1 +/- 11.8 mg2/dL2) versus 3.97 +/- 1.18 mmol2/L2 (49.7 +/- 14.7 mg2/dL2), P = 0.0009). Only 36% of patients on sevelamer hydrochloride compared with 68% on CCB (P = 0.015) met the serum phosphorus goal of < or =1.78 mmol/L. CONCLUSION: Patients on sevelamer hydrochloride for >1 years compared to those on CCB had a lower serum bicarbonate concentration, a higher serum phosphorus concentration and a higher Ca-P product. Clinicians should balance the increase in calcium load with CCB versus the cost and effectiveness of sevelamer hydrochloride in choosing a phosphate binder for ESRD patients.     

A Comparison of Sevelamer Hydrochloride with Calcium Acetate on Biomarkers of Bone Turnover in Hemodialysis Patients

Objective. To evaluate the influence of sevelamer hydrochloride and calcium acetate on biomarkers of bone turnover in patients with hyperphosphatemia receiving hemodialysis. Methods. In this prospective, open-label, randomized, active-controlled study, 70 patients (38 men and 32 women) with hyperphosphatemia (serum phosphorus level >6.0 mg/dL) underwent a two-week washout period and were randomly selected to receive sevelamer hydrochloride (n = 37) or calcium acetate (n = 33) for eight weeks. Changes in serum levels of intact parathyroid hormone (iPTH), alkaline phosphatase (Alk-P), phosphorus, and calcium were measured and compared. Results. After eight weeks of treatment, calcium acetate lowered iPTH levels significantly more than sevelamer hydrochloride did (?178.0 vs. ?69.0 pg/mL, p = 0.0019). Levels of Alk-P were significantly elevated in patients given sevelamer hydrochloride compared with levels in those given calcium acetate treatment (24.09 vs. 7.45 U/L, p = 0.0014). Changes in serum phosphorus levels did not differ between sevelamer hydrochloride (?1.93 mg/dL) and calcium acetate (?2.5 mg/dL) at the end of the study (p = 0.0514). Changes in the calcium and phosphorous product did not significantly differ between the sevelamer-hydrochloride group (?18.06 mg²/dL²) and the calcium-acetate group (?19.05 mg²/dL², p = 0.6764). Fifteen patients (45.5%) treated with calcium acetate had hypercalcemia (serum-adjusted calcium level >10.5 mg/dL); the rate was significantly higher than that of patients treated with sevelamer (five [13.5%] of 37, p = 0.0039). Conclusion. Treatment with sevelamer hydrochloride had the advantage of maintaining stable iPTH levels and elevating Alk-P levels while lowering serum phosphorus levels and calcium-phosphorous product.     

Sevelamer hydrochloride: an effective phosphate binder in dialyzed children

This pilot study was designed to evaluate the efficacy and acceptability of sevelamer hydrochloride as a phosphate binder in pediatric patients treated with dialysis. A 6-month open-label trial of sevelamer hydrochloride (Renagel) was initiated in 17 patients, aged 11.8±3.7 years, undergoing hemodialysis (n=3) or peritoneal dialysis (n=14). Following a 2-week washout period of the phosphate binders, serum phosphorus increased from 5.2±1.3 mg/dl to 7.5±2.2 mg/dl (P<0.0002). After initiation of therapy with sevelamer hydrochloride, serum phosphorus levels decreased to 6.2±1.2 mg/dl (P<0.01) during the first 8 weeks and final values were 6.3±1.5 mg/dl. Serum calcium concentration decreased during the washout period from 9.4±0.9 mg/dl to 8.9±1.5 mg/dl (P<0.01); values remained unchanged thereafter. The serum calcium-phosphorus ion product decreased during the first 8 weeks and values did not change subsequently. Serum bicarbonate, parathyroid hormone, total cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol, and triglyceride levels did not change. The initial prescribed dose of sevelamer hydrochloride was 121±50 mg/kg (4.5±5 g/day) and the final prescribed dose was 163±46 mg/kg (6.7±2.4 g/day). Sevelamer hydrochloride was well tolerated and without adverse effects related to the drug.     

Efficacy and safety of calcium acetate on hyperphosphatemia in patients undergoing hemodialysis

Objective To evaluate the efficacy and safety of calcium acetate in treating hemodialysis(HD) patients with hyperphosphatemia. Methods A randomized, controlled multicenter study was performed. Phosphate binders were discontinued during a two-week washout period． A total of 171 hemodialysis patients from 10 sites with serum phosphorus during 1.94-2.75 mmol/L after two-week washout period were randomized to calcium acetate or calcium carbonate for 8 - week treatment period. Patients with serum phosphorus between 1.94-2.26 mmol/L were given elemental calcium 1000 mg/d and between 2.27- 2.75 mmol/L were given elemental calcium 1500 mg/d. The dose was constant during the 8 - week treatment period. Results All of 171 patients entered the safety analysis set, including 123 cases who completed the study into effect analysis set. In terms of efficacy: compared with the baseline, serum phosphorus, calcium - phosphorus products, parathyroid hormone (iPTH) levels were significantly decreased (all P＜0.05) and serum calcium levels increased slightly in both groups; compared with the calcium carbonate group, calcium acetate group had a significant advantage in the change of serum phosphorus content [(1.73 ± 1.85) vs (0.99 ± 1.60) mmol/L, P＜0.05] and drug response ratio (compared with the baseline serum phosphorus level fell more than 25%) (51.6% vs 32.8%, P＜0.05). In safety aspects, calcium acetate group and the control group had no significant differences in the incidence of adverse events (19.8% vs 18.8%) and adverse reactions (8.1% vs 4.7%), all P＞0.05. The main adverse reactions of calcium acetate were mild to moderate gastrointestinal reactions, including nausea, vomiting. Conclusions In hemodialysis patients with hyperphosphatemia, calcium acetate can decrease serum phosphorus and reduce the levels of calcium - phosphorus product and iPTH. In the phosphate binding capacity, calcium acetate is superior to calcium carbonate. Mild to moderate gastrointestinal reactions are most common after administration.     

Treatment of hyperphosphatemia with sevelamer hydrochloride in hemodialysis patients: a comparison with calcium acetate

BACKGROUND: Sevelamer hydrochloride is a recently approved calcium- and aluminium-free phosphate binder. A randomized study comparing sevelamer and calcium acetate was performed to assess the control of hyperphosphatemia in hemodialysis patients. METHODS: Administration of phosphate binders was discontinued during a two-week washout period. The patients were then randomized to receive sevelamer or calcium acetate. The laboratory tests were performed monthly for 34 weeks. RESULTS: There was a statistically significant decrease of serum phosphorus in both sevelamer and calcium acetate treatments. In addition, sevelamer improved the lipid profile. CONCLUSION: This study confirms that sevelamer is effective at lowering serum phosphorus in hemodialysis patients and that it has several striking properties that could be beneficial in atherosclerosis in dialysis patients.     

Sevelamer reduces calcium load and maintains a low calcium-phosphorus ion product in dialysis patients.

BACKGROUND: Sevelamer HCl, a non-aluminum, non-calcium containing hydrogel, has proved an effective phosphate binder in North American hemodialysis patients. This single-center, open-label, dose titration study assessed the efficacy of sevelamer in a cohort of European hemodialysis patients with different dietary habits, in particular with lower phosphate intake. The aim of the study was to obtain a calcium x phosphate product lower than 60 mg2/dL2 in all patients. METHODS: Administration of calcium- or aluminum-based phosphate binders was discontinued during a two-week washout period. Nineteen patients whose serum phosphate level at the end of washout was greater than 5.5 mg/dL (1.78 mmol/L) qualified to receive sevelamer for six weeks. Based on the degree of hyperphosphatemia during washout, patients were started on 403 mg sevelamer capsules with a dose schedule different from previous studies. Only one capsule was administered at breakfast, and the rest of the phosphate binder was divided equally at the two main meals. Sevelamer could be increased by two capsules per day every two weeks, if necessary. A second two-week washout period followed. RESULTS: Mean serum phosphorus rose from a baseline of 5.3 +/- 1.0 to 7.4 +/- 1.4 mg/dL at the end of washout, then declined to 5.4 +/- 0.8 mg/dL (p < 0.001) by the end of the six-week treatment period and rebounded significantly to 7.1 +/- 1.1 mg/dL after the second two-week washout. Calcium x phosphate product showed a similar pattern, decreasing significantly from 64.1 +/- 14.1 to 46.9 +/- 7.4 mg2/dL2 (p < 0.001) after six weeks of sevelamer. A level of less than 50 mg2/dL2 was reached by 68% of patients, and 95% had less than 60 mg2/dL2. The mean dose of sevelamer at the end of treatment was 3.1 +/- 0.6 g per day. As expected, calcium declined from 9.2 +/- 0.5 to 8.7 mg/dL (p < 0.01) during the initial washout after stopping calcium-based phosphate binders, but remained stable thereafter. Ionized calcium did not change significantly throughout the washout and sevelamer treatment. However, interruption of calcium salts led to a 81% reduction of total calcium intake. CONCLUSIONS: We confirmed in an European sample of hemodialysis patients that sevelamer can reduce phosphate levels without inducing hypercalcemia. The drug can also be successfully used to reduce mean calcium x phosphate levels below 50 mg2/dL2, closer to normal values. Although similar results can be obtained with other phosphate binders, a concomitant accumulation of aluminum, calcium or magnesium could be detrimental to patients.     

慢性肾炎患者血浆海蟾蜍毒素水平及其肾脏受体表达变化

目的 了解慢性肾小球肾炎（CGN）患者血浆海蟾蜍毒素（MBG）水平及其受体Na+-K+-ATP酶（NKA）在肾组织中的表达情况。 方法 竞争抑制ELISA法测定28例CGN患者和14例健康人血浆MBG浓度。应用免疫荧光共聚焦、免疫组化和图像分析技术检测CGN患者肾组织内NKA的表达部位及表达量。 结果 CGN患者血浆MBG浓度低于健康对照组[（0.579±0.214） nmol/L比（0.715±0.154） nmol/L,P < 0.05],其中高血压者与血压正常者血浆MBG浓度差异无统计学意义[（0.595±0.231） nmol/L比（0.557±0.197） nmol/L,P > 0.05]。血浆MBG浓度与24 h尿钠排泄量无相关（r = -0.022,P > 0.05）。与正常肾组织比较,CGN患者近端肾小管NKA表达下降,肾小管NKA表达阳性面积百分比明显减少[2.1%（0.5%~6.2%）比 5.6%（3.5%~10.8%）,P < 0.01],且与24 h尿钠排泄量呈正相关（r = 0.551,P < 0.01）。 结论 CGN患者血浆MBG水平及其受体NKA在近端肾小管表达的下降可能参与CGN患者钠代谢调节。     

Long-term comparison of a calcium-free phosphate binder and calcium carbonate--phosphorus metabolism and cardiovascular calcification

BACKGROUND: Calcium carbonate used as a phosphate binder may contribute to cardiovascular calcification. Long-term comparisons of sevelamer, a non-calcium polymeric phosphate binder, and calcium carbonate (CC) are lacking. METHODS: 114 adult hemodialysis patients were randomly assigned to open label sevelamer or CC for 52 weeks. Study efficacy endpoints included changes in serum phosphorus, calcium, calcium-phosphorus product, and lipids. In addition, initial and sequential electron beam computerized tomography scans were performed to assess cardiovascular calcification status and change during follow-up. Safety endpoints were serum biochemistry, blood cell counts and adverse events. RESULTS: Patients receiving sevelamer had a similar reduction in serum phosphorus as patients receiving CC (sevelamer -0.58 +/- 0.68 mmol/l, CC -0.52 +/- 0.50 mmol/l; p = 0.62). Reductions in calcium-phosphorus product were not significantly different (sevelamer -1.4 +/- 1.7 mmol2/l2, CC -0.9 +/- 1.2 mmol2/l2; p = 0.12). CC produced significantly more hypercalcemia (> 2.8 mmol/l in 0% sevelamer and 19% CC patients, p < 0.01) and suppressed intact parathyroid hormone below 150 pg/ml in the majority of patients. Sevelamer patients experienced significant (p < 0.01) reductions in total (-1.2 +/- 0.9 mmol/l, -24%) and LDL cholesterol (-1.2 +/- 0.9 mmol/l, -30%). CC patients had significant increases in coronary artery (median +34%, p < 0.01) and aortic calcification (median +32%, p < 0.01) that were not observed in sevelamer-treated patients. Patients on sevelamer required more grams of binder (sevelamer 5.9 g vs. CC 3.9 g) and experienced more dyspepsia than patients on calcium carbonate. CONCLUSIONS: Sevelamer is an effective phosphate binder that unlike calcium carbonate is not associated with progressive cardiovascular calcification in hemodialysis patients.