Cozzolino M, Brancaccio D
Renal Division, Department of Medicine, Surgery, and Dentistry, San Paolo Hospital, University of Milan, Milan - Italy.
Int J Artif Organs. 2007 Apr;30(4):293-300. doi: 10.1177/039139880703000403.
Phosphate overload is a dramatic consequence in end-stage renal disease (ESRD) patients. Recent studies have well documented that abnormalities in mineral and bone metabolism in these patients are associated with increased cardiovascular morbidity and mortality. Elevated serum phosphate and calcium-phosphate product levels play an important role in the pathogenesis of secondary hyperparathyroidism and extra-skeletal calcification in dialysis patients. Furthermore, inorganic phosphate may cause vascular calcification directly through a real ""ossification"" of the tunica media in the vasculature of ESRD patients. The ""classical"" treatment of secondary hyperparathyroidism and hyperphosphatemia in ESRD patients consists of either calcium- or aluminum-based phosphate binders and calcitriol administration. Unfortunately, this ""old generation"" therapy is not free of complications. This review paper suggests that new calcium- and aluminum-free phosphate binders, such as lanthanum carbonate, can be used to treat hyperphosphatemia and secondary hyperparathyroidism in ESRD patients.
磷过载是终末期肾病（ESRD）患者的一个严重后果。最近的研究充分证明，这些患者的矿物质和骨代谢异常与心血管发病率和死亡率增加有关。血清磷水平升高以及钙磷乘积升高在透析患者继发性甲状旁腺功能亢进和骨骼外钙化的发病机制中起重要作用。此外，无机磷可能通过ESRD患者血管中膜真正的“骨化”直接导致血管钙化。ESRD患者继发性甲状旁腺功能亢进和高磷血症的“经典”治疗方法包括使用钙基或铝基磷结合剂以及给予骨化三醇。不幸的是，这种“第一代”疗法并非没有并发症。这篇综述文章表明，新型无钙和无铝的磷结合剂，如碳酸镧，可用于治疗ESRD患者的高磷血症和继发性甲状旁腺功能亢进。
