Friedman Eli A
Department of Medicine, Renal Disease Division, Downstate Medical Center, Brooklyn, NY 11203, USA.
Clin J Am Soc Nephrol. 2006 Jul;1(4):704-9. doi: 10.2215/CJN.01831105. Epub 2006 May 3.
Many nephrologists feel threatened by the allegation that, in patients with chronic renal failure, treatment with calcium-based phosphate binders (calcium acetate and calcium carbonate) may induce coronary artery and cardiac calcification, thereby imposing a greater risk for death compared with sevelamer, a non-calcium-based binder. Acknowledging that drug manufacturers are not unaware of the marketing advantage to their product consequent to destabilizing demand for competing drugs, the case for and against abandoning calcium-based phosphate binders in favor of sevelamer is reviewed in this study. The case for continuing prescription of calcium-based phosphate binders stands on the following: (1) flawed clinical trials that favor sevelamer as a replacement; (2) weak evidence that oral calcium intake modulates vascular and/or cardiac calcification; (3) clinical trials that reinforce the safety and efficacy of calcium-based phosphate binders; and (4) the inordinate relative cost of sevelamer. Recognizing that established as well as novel phosphate binders are currently undergoing clinical evaluation, an open mind and an awareness of developing literature are necessary when deciding how to manage hyperphosphatemia in renal failure.
对于慢性肾衰竭患者，使用钙基磷酸盐结合剂（醋酸钙和碳酸钙）进行治疗可能会导致冠状动脉和心脏钙化，因此与非钙基结合剂司维拉姆相比，会带来更高的死亡风险。鉴于药品制造商并非没有意识到，对竞争药物需求的不稳定会给他们的产品带来营销优势，本研究对支持和反对摒弃钙基磷酸盐结合剂而选用司维拉姆的理由进行了综述。继续使用钙基磷酸盐结合剂进行处方的理由如下：（1）支持司维拉姆作为替代品的临床试验存在缺陷；（2）口服钙摄入调节血管和/或心脏钙化的证据不足；（3）强化钙基磷酸盐结合剂安全性和有效性的临床试验；（4）司维拉姆相对成本过高。认识到现有及新型磷酸盐结合剂目前正在进行临床评估，在决定如何处理肾衰竭患者的高磷血症时，保持开放的心态并关注不断发展的文献是很有必要的。
