Chertow Glenn M, Raggi Paolo, McCarthy James T, Schulman Gerald, Silberzweig Jeffrey, Kuhlik Amy, Goodman William G, Boulay Amy, Burke Steven K, Toto Robert D
Division of Nephrology, Moffitt-Long Hospitals and UCSF-Mt. Zion Medical Center, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Am J Nephrol. 2003 Sep-Oct;23(5):307-14. doi: 10.1159/000072822. Epub 2003 Aug 12.
We recently determined that in hemodialysis patients, the use of calcium salts to correct hyperphosphatemia led to progressive coronary artery and aortic calcification as determined by sequential electron beam tomography (EBT) while the use of the non-calcium-containing binder sevelamer did not. Whether the specific calcium preparation (acetate vs. carbonate) might influence the likelihood of progressive calcification was debated.
To determine whether treatment with calcium acetate was specifically associated with hypercalcemia and progressive vascular calcification, we conducted an analysis restricted to 108 hemodialysis patients randomized to calcium acetate or sevelamer and followed for one year.
The reduction in serum phosphorus was roughly equivalent with both agents (calcium acetate -2.5 +/- 1.8 mg/dl vs. sevelamer -2.8 +/- 2.0 mg/dl, p = 0.53). Subjects given calcium acetate were more likely to develop hypercalcemia (defined as an albumin-corrected serum calcium > or =10.5 mg/dl) (36 vs. 13%, p = 0.015). Treatment with calcium acetate (mean 4.6 +/- 2.1 g/day - equivalent to 1.2 +/- 0.5 g of elemental calcium) led to a significant increase in EBT-determined calcification of the coronary arteries (mean change 182 +/- 350, median change +20, p = 0.002) and aorta (mean change 181 +/- 855, median change +73, p < 0.0001). These changes were similar in magnitude to those seen with calcium carbonate. There were no significant changes in calcification among sevelamer-treated subjects.
Despite purported differences in safety and efficacy relative to calcium carbonate, calcium acetate led to hypercalcemia and progressive vascular calcification in hemodialysis patients.
我们最近发现，在血液透析患者中，使用钙盐纠正高磷血症会导致冠状动脉和主动脉逐渐钙化，这是通过连续电子束断层扫描（EBT）确定的，而使用不含钙的结合剂司维拉姆则不会。特定的钙制剂（醋酸盐与碳酸盐）是否会影响逐渐钙化的可能性存在争议。
为了确定醋酸钙治疗是否与高钙血症和血管逐渐钙化有特定关联，我们对108例随机接受醋酸钙或司维拉姆治疗并随访一年的血液透析患者进行了分析。
两种药物降低血清磷的效果大致相当（醋酸钙-2.5±1.8mg/dl，司维拉姆-2.8±2.0mg/dl，p = 0.53）。接受醋酸钙治疗的受试者更易发生高钙血症（定义为白蛋白校正后的血清钙≥10.5mg/dl）（36%对13%，p = 0.015）。醋酸钙治疗（平均4.6±2.1g/天 - 相当于1.2±0.5g元素钙）导致EBT测定的冠状动脉钙化显著增加（平均变化182±350，中位数变化+20，p = 0.002）和主动脉钙化（平均变化181±855，中位数变化+73，p < 0.0001）。这些变化的幅度与碳酸钙治疗时观察到的相似。司维拉姆治疗的受试者钙化无显著变化。
尽管据称醋酸钙相对于碳酸钙在安全性和疗效方面存在差异，但醋酸钙仍会导致血液透析患者出现高钙血症和血管逐渐钙化。
