Altmann P, Barnett M E, Finn W F
Oxford Kidney Unit, Oxford Radcliffe Hospitals NHS Trust and University of Oxford, Oxford, UK.
Kidney Int. 2007 Feb;71(3):252-9. doi: 10.1038/sj.ki.5001932. Epub 2006 Oct 11.
Patients with Stage 5 chronic kidney disease who have hyperphosphatemia require treatment with phosphate binders to lower serum phosphorus levels. Existing binders are effective but may be associated with important safety disadvantages. Lanthanum carbonate is a phosphate binder with demonstrated efficacy, safety, and tolerability in clinical trials. Changes in cognitive function were evaluated over time using the Cognitive Drug Research computerized cognitive assessment system (Simple Reaction Time, Digit Vigilance Task, Choice Reaction Time, Numeric Working Memory, and Delayed Picture Recognition) in 360 hemodialysis patients who were enrolled in a 2-year, multicenter, comparative study of lanthanum carbonate versus standard therapy. A decline in cognitive function from baseline was observed in both groups. The deterioration in cognitive function was similar in both the lanthanum carbonate and standard therapy groups. One parameter - Numeric Working Memory - showed a statistically significant between-group difference in favor of lanthanum carbonate (P=0.02). Given the magnitude of the changes, however, and the differences that were observed at baseline between treatment groups, the clinical significance of this difference is doubtful. This study demonstrates that cognitive function deteriorates in hemodialysis patients over a 2-year time period. Use of lanthanum carbonate as a phosphate binder does not adversely affect cognitive function compared with standard therapy.
患有5期慢性肾脏病且伴有高磷血症的患者需要使用磷结合剂进行治疗，以降低血清磷水平。现有的磷结合剂虽有疗效，但可能存在一些严重的安全缺陷。碳酸镧是一种磷结合剂，在临床试验中已证明其有效性、安全性和耐受性。在一项为期2年的多中心碳酸镧与标准疗法对比研究中，对360名接受血液透析的患者使用认知药物研究计算机化认知评估系统（简单反应时间、数字警觉任务、选择反应时间、数字工作记忆和延迟图片识别），随时间评估认知功能变化。两组均观察到认知功能较基线水平下降。碳酸镧组和标准疗法组的认知功能恶化情况相似。一个参数——数字工作记忆——显示两组间存在统计学显著差异，碳酸镧组更具优势（P = 0.02）。然而，鉴于变化幅度以及治疗组间在基线时观察到的差异，这种差异的临床意义存疑。本研究表明，血液透析患者的认知功能在2年期间会恶化。与标准疗法相比，使用碳酸镧作为磷结合剂不会对认知功能产生不利影响。
