Iwasaki Youichi, Takami Hiroya, Tani Masahide, Yamaguchi Yoshiyuki, Goto Hiromichi, Goto Yoshikazu, Goto Yoshiaki, Shigematsu Takashi
Saiyu Kawaguchi Clinic, Saiyu Soka Hospital, Saitama, Japan.
Ther Apher Dial. 2005 Aug;9(4):347-51. doi: 10.1111/j.1744-9987.2005.00295.x.
In Japan, calcimimetics and other phosphate binders such as lantanum carbonate are not available for patients on long-term hemodialysis (HD), so we prospectively evaluated the clinical efficacy of the combination of sevelamer hydrochloride and calcium carbonate (CaCO3) for hyperphosphatemia. The study group comprised 65 HD patients who had been administered CaCO3 (>or=1500 mg/day) for hyperphosphatemia [>or=6.0 mg/dL (>or=1.94 mmol/L)]. At the beginning of the study the dose of CaCO3 was reduced by 1500 mg/day and the patients divided into two groups according to the dose of additional sevelamer hydrochloride: group A 2250 mg/day; group B 3000 mg/day. Oral active vitamin D therapy was unchanged. Fourteen patients (21.5%) dropped out because of adverse effects and of the 51 remaining patients 35 (53.8%) suffered from gastrointestinal problems. Serum phosphate concentration decreased significantly [from 7.5+/-0.8 mg/dL (2.42+/-0.26 mmol/L) to 6.6+/-1.3 mg/dL (2.13+/-0.42 mmol/L), P<0.01] in group B only after the 8 weeks of combination therapy. The calcium-phosphate product (CaxPi) also decreased in group B only [from 74.4+/-13.4 mg2/dL2 (5.99+/-1.07 mmol2/l2) to 63.7+/-15.8 mg2/dL2 (5.13+/-1.27 mmol2/l2), P<0.001]. The combination of sevelamer hydrochloride and CaCO3 is a suitable regimen for hyperphosphatemia treatment in HD patients because it avoids both the hypercalcemia of CaCO3 and the adverse effects of sevelamer hydrochloride when each is used as single-drug therapy. The ability of sevelamer hydrochloride to decrease the serum phosphate concentration is 2/3 (2250/1500 mg) that of CaCO3.
在日本，拟钙剂和其他磷结合剂（如碳酸镧）无法用于长期血液透析（HD）患者，因此我们前瞻性地评估了盐酸司维拉姆和碳酸钙（CaCO₃）联合使用治疗高磷血症的临床疗效。研究组包括65例因高磷血症[≥6.0mg/dL（≥1.94mmol/L）]而接受CaCO₃治疗（≥1500mg/天）的HD患者。在研究开始时，将CaCO₃的剂量减少1500mg/天，并根据额外添加的盐酸司维拉姆剂量将患者分为两组：A组2250mg/天；B组3000mg/天。口服活性维生素D治疗保持不变。14例患者（21.5%）因不良反应退出，在剩余的51例患者中，35例（53.8%）出现胃肠道问题。仅在联合治疗8周后，B组的血清磷浓度显著降低[从7.5±0.8mg/dL（2.42±0.26mmol/L）降至6.6±1.3mg/dL（2.13±0.42mmol/L），P<0.01]。钙磷乘积（CaxPi）也仅在B组降低[从74.4±13.4mg²/dL²（5.99±1.07mmol²/l²）降至63.7±15.8mg²/dL²（5.13±1.27mmol²/l²），P<0.001]。盐酸司维拉姆和CaCO₃联合使用是HD患者高磷血症治疗的合适方案，因为当它们各自作为单一药物治疗时，既能避免CaCO₃引起的高钙血症，又能避免盐酸司维拉姆的不良反应。盐酸司维拉姆降低血清磷浓度的能力是CaCO₃的2/3（2250/1500mg）。
