Saif Imran, Halim Abdul, Altaf Ashfaq, Saif Mohsin, Khalid Muhammad, Ahmad Dilshad, Imran Humera
Department of Nephrology, Military Hospital, Rawalpindi.
J Ayub Med Coll Abbottabad. 2007 Oct-Dec;19(4):26-8.
Hyperphosphatemia is common in end-stage renal disease patients. Objective of this study is to compare the hypercalcaemic effect and phosphate binding power of calcium acetate and calcium carbonate in end-stage renal disease patients on maintenance haemodialysis.
This randomised control trial was conducted in four phases with calcium acetate or calcium carbonate. Sixty-four patients on haemodialysis were randomly divided into 2 groups. After a washout period of 2 weeks, each group was given calcium acetate or calcium carbonate for 2 months. After another washout period the patients were crossed over and again received these drugs for 2 months. Serum Calcium, phosphate, and albumin were analysed on Selectra E auto analyser at completion of each phase of study. Hypercalcaemic effect was defined as serum calcium > 2.54 mmol/l, and phosphate binding power as serum phosphate < 1.61 mmol/l.
Forty-one patients completed the study. Though lower dose of calcium acetate was used, it resulted in equally good control of hyperphosphatemia as compared with calcium carbonate therapy [1.37 mmol/l (SD 0.33) vs. 1.46 mmol/l (SD 0.34), p = 0.16]. Incidence of hypercalcaemia was higher with calcium carbonate therapy (2.73 +/- 0.67 mmol/l vs. 2.32 +/- 0.28 mmol/l, p < 0.01). Both drugs were well tolerated, but patients more frequently complained of muscle cramps while taking calcium acetate.
It is concluded that calcium acetate has similar effect on serum phosphate levels as compared to calcium carbonate in patients on maintenance haemodialysis. However, calcium acetate results in lesser frequency of hypercalcaemia as compared to calcium carbonate. Tolerance to both drugs was similar, though patients complained of more muscle cramps while taking calcium acetate.
高磷血症在终末期肾病患者中很常见。本研究的目的是比较醋酸钙和碳酸钙对维持性血液透析的终末期肾病患者的高钙血症效应和磷结合能力。
本随机对照试验分四个阶段使用醋酸钙或碳酸钙进行。64例血液透析患者被随机分为两组。经过2周的洗脱期后，每组给予醋酸钙或碳酸钙2个月。在另一个洗脱期后，患者交叉用药，再次接受这些药物治疗2个月。在研究的每个阶段结束时，使用Selectra E自动分析仪分析血清钙、磷和白蛋白。高钙血症效应定义为血清钙>2.54 mmol/L，磷结合能力定义为血清磷<1.61 mmol/L。
41例患者完成了研究。虽然使用的醋酸钙剂量较低，但与碳酸钙治疗相比，其对高磷血症的控制效果同样良好[1.37 mmol/L（标准差0.33）对1.46 mmol/L（标准差0.34），p = 0.16]。碳酸钙治疗的高钙血症发生率更高（2.73±0.67 mmol/L对2.32±0.28 mmol/L，p<0.01）。两种药物耐受性均良好，但患者在服用醋酸钙时更频繁地抱怨肌肉痉挛。
得出结论，在维持性血液透析患者中，醋酸钙与碳酸钙对血清磷水平的影响相似。然而，与碳酸钙相比，醋酸钙导致高钙血症的频率较低。两种药物的耐受性相似，尽管患者在服用醋酸钙时抱怨更多的肌肉痉挛。
