Sonikian Macroui, Metaxaki Polyxeni, Iliopoulos Anastasios, Marioli Stamatia, Vlassopoulos Dimosthenis
Nephrology Department, A. Fleming General Hospital, Athens, Greece.
Ren Fail. 2006;28(5):411-8. doi: 10.1080/08860220600599092.
Sevelamer hydrochloride use in hemodialysis patients is complicated by metabolic acidosis aggravation and hyperkalemia. Rare reports about a short-term correction of this complication have been published. The current authors investigated the long-term correction of metabolic acidosis and hyperkalemia in sevelamer hydrochloride-treated patients at doses adequate to achieve serum phosphate levels within K/DOQI recommendations. The authors followed 20 hemodialysis patients for 24 months in an open-label prospective study. The dialysate bicarbonate concentration was increased stepwise to a maximum 40 mEq/L and adjusted to reach patient serum bicarbonate levels of 22 mEq/L, according to K/DOQI recommendations. Laboratory results for serum bicarbonate, potassium, calcium, phosphate, albumin, alkaline phosphatase, iPTH, cholesterol (HDL-LDL), triglycerides, Kt/V, systolic-diastolic arterial pressure were recorded. Sevelamer hydrochloride-induced metabolic acidosis aggravation and hyperkalemia in hemodialysis patients were corrected, on the long-term, by an increase in dialysate bicarbonate concentration. Further improvement in bone biochemistry was noted with this adequate acidosis correction and parallel sevelamer hydrochloride administration, in sufficiently large doses to achieve K/DOQI phosphate recommendations.
血液透析患者使用盐酸司维拉姆会出现代谢性酸中毒加重和高钾血症等复杂情况。关于这种并发症短期纠正的报道较少。本文作者研究了在使用足以使血清磷水平达到K/DOQI推荐范围的剂量的盐酸司维拉姆治疗的患者中，代谢性酸中毒和高钾血症的长期纠正情况。作者在一项开放标签前瞻性研究中对20例血液透析患者进行了24个月的随访。根据K/DOQI推荐，逐步提高透析液碳酸氢盐浓度至最高40 mEq/L，并进行调整以使患者血清碳酸氢盐水平达到22 mEq/L。记录血清碳酸氢盐、钾、钙、磷、白蛋白、碱性磷酸酶、iPTH、胆固醇（高密度脂蛋白-低密度脂蛋白）、甘油三酯、Kt/V、收缩压-舒张压等实验室检查结果。长期来看，通过提高透析液碳酸氢盐浓度可纠正血液透析患者中盐酸司维拉姆引起的代谢性酸中毒加重和高钾血症。在充分纠正酸中毒并同时给予足够大剂量的盐酸司维拉姆以达到K/DOQI磷推荐范围时，骨生化指标有进一步改善。
