司维拉姆治疗维持性血液透析高磷血症的疗效观察

目的探讨碳酸司维拉姆片治疗维持性血液透析高磷血症的临床疗效。方法选取2018年6月—2019年6月在六安市人民医院治疗的76例血液透析合并高磷血症的患者,将所有患者按照数字随机抽取分为对照组和治疗组,每组各38例。对照组餐中嚼服碳酸钙D3片,1～2次/d,0.6～1.2 g/d;治疗组餐中同服碳酸司维拉姆片,1～2次/d,0.8～1.6 g/d。两组患者连续治疗6个月。观察两组的临床疗效,比较两组患者的血磷、血钙、钙磷乘积、甲状旁腺素(PTH)、白蛋白、血红蛋白水平。结果治疗后,对照组总有效率是57.89%,治疗组总有效率是76.32%,两组总有效率比较差异有统计学意义(P0.05)。治疗3、6个月后,两组患者的血磷、钙磷乘积较治疗前均下降(P0.05);且治疗组的血磷、钙磷乘积的下降比对照组更明显(P0.05)。治疗3、6个月后,对照组血钙显著升高,治疗组血钙呈下降趋势(P0.05),且治疗组的血钙明显低于对照组(P0.05)。治疗3、6个月后,两组患者血红蛋白、白蛋白比较均无明显差异。治疗3、6个月后,两组患者PTH均显著降低(P0.05),但两组的PTH对比无差异。结论碳酸司维拉姆片治疗维持性血液透析高磷血症的疗效较好,可降低患者血磷、钙磷乘积,不引起高钙血症,对患者的营养状况没有影响。     

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.     

3-5期CKD患者高磷血症发病情况及危险因素分析

SS目的：探讨3-5期CKD患者高磷血症发病情况并对其危险因素分析,以期为临床提供指导。方法：选取我院2017年1月~2019年1月我院收治的3-5期CKD患者820例,分析患者高血磷的发生情况,采用单因素分析方法分析血磷与年龄、性别、肾脏替代疗法(血液透析疗法、腹膜疗法)、肾功能、合并症(高血压病史、心血管病史、糖尿病病史)、蛋白尿、吸烟、饮酒、病因、透析龄,采用多因素logistic回归分析探讨影响血磷水平的因素。结果：820例3-5期CKD患者合并高磷血症者269例,发生率为32.80%,其中3期患者中高磷血症者为34例,占9.94%;4期患者中高磷血症者为77例,占30.67%;5期患者中高磷血症者为158例,占69.60%。单因素分析结果显示：两组在性别、年龄、合并糖尿病、合并高血压、蛋白尿、肾功能分期、透析龄差异具有统计学意义(P<0.05)。多因素logistic回归模型进一步分析,结果显示：性别为男性、透析龄长、肾功能分期为5期及合并高血压是高磷血症的独立危险因素。结论：男性、透析龄长、肾功能分期为5期及合并高血压是高磷血症的独立危险因素,对于合并危险因素的CKD患者更应该对其进行宣传教育,注意食用限磷食物及低蛋白食物,必要时可以给予磷结合剂。     

药用炭片联合碳酸镧咀嚼片对维持性血液透析并发高磷血症患者的疗效及安全性

目的探讨药用炭片联合碳酸镧咀嚼片治疗维持性血液透析并发高磷血症患者的临床疗效及安全性。方法选取该院2016年1月至2017年12月收治的148例维持性血液透析并发高磷血症患者为研究对象,采用随机数字表法分为观察组与对照组,每组74例。两组均给予碳酸镧咀嚼片治疗,观察组同时给予药用炭片治疗,两组均连续治疗3个月。比较两组临床疗效,治疗前后血磷、血钙、血甲状旁腺激素(PTH)水平、左心室质量指数(LVMI)、冠状动脉钙化积分(CACS)变化及不良反应发生情况。结果观察组治疗后显效率、总有效率分别为77.03%、98.65%,较对照组的40.54%、89.19%明显上升,差异有统计学意义(P<0.05)。两组治疗后血磷、血钙、血PTH水平均较治疗前明显降低,与治疗前比较,差异有统计学意义(P<0.05);且观察组下降更明显,与对照组治疗后比较,差异有统计学意义(P<0.05)。观察组治疗前后LVMI、CACS均无明显变化(P>0.05);对照组治疗后CACS较治疗前明显升高,差异有统计学意义(P<0.05),LVMI无明显改变,与治疗前比较,差异无统计学意义(P>0.05)。观察组不良反应发生率为9.46%,对照组为8.11%,两组比较差异无统计学意义(P>0.05)。结论药用炭片联合碳酸镧咀嚼片治疗维持性血液透析并发高磷血症患者可取得明显疗效,且治疗过程中无明显不良反应。     

Phosphate binders usage,patients knowledge,and adherence: A cross-sectional study in 4 centers at Qassim,Saudi Arabia

Objectives:To assess phosphate binders’ usage, knowledge regarding their utilization, and adherence among hemodialysis patients in Qassim, Saudi Arabia.Methods:A prospective cross-sectional study conducted at 4 dialysis centers in Qassim, Saudi Arabia with inclusion of 237 patients’ undergoing hemodialysis between November 2018 to January 2019. The study involved interviewing the patients, reviewing their medical records for biomarkers used to assess kidney function, and assessing the patients’ knowledge-based regarding dietary phosphate control, as well as adherence to phosphate binders’ usage.Results:Out of 237 included patients, male to female ratio was 54:46. The prevalence of prescribing non-calcium phosphate binders was 82.7% whereas prescribing calcium phosphate binders was 73.8%. A total of 63% of patients showed a medium level of adherence to phosphate binders. Although adherence level was not poor, therapeutic efficacy was affected by other factors such as administration time adherence positively correlated with the serum phosphate level (p=0.00).Conclusion:Phosphate binders usage is frequent among hemodialysis patients in Qassim centers. Circulating phosphate level was affected by the extent of patients’ knowledge of dietary control and adherence to the usage of phosphate binders. Thus, we recommend enhancing patient education in reference to high- and low- phosphate-rich diet to take wise dietary decisions, lower pill burden, and improve adherence toward the control of hyperphosphatemia     

Severe hyperphosphatemia following acute tumor lysis syndrome

We report on a 14-year-old boy with acute lymphoblastic leukemia (lymphomaleukemia) who had two episodes of acute tumor lysis syndrome during induction of remission with oral prednisolone alone and oral prednisolone, intravenous vincristine, and doxorubicin, respectively. Subsequently he had severe hyperphosphatemia (29.3 and 14.1 mg/dl; 9.46 and 4.55 mmol/L), hypocalcemia, hyperuricemia, hyperkalemia, and azotemia. Multiple stones and tumor cells infiltration were demonstrated in both kidneys. He responded favorably to hemodialysis. © 1995 Wiley-Liss, Inc.