Experimental and Clinic Department of Internal Medicine and Pharmacology, University of Messina, Italy.
Ther Clin Risk Manag. 2008 Aug;4(4):821-6. doi: 10.2147/tcrm.s3075.
Sevelamer carbonate is an anion exchange pharmaceutical, developed to improve on the performance of the non-absorbable, non-calcium, and metal-free phosphate binder sevelamer hydrochloride. Sevelamer carbonate is expected not to worsen metabolic acidosis, as previously reported during long-term treatment with sevelamer hydrochloride in hemodialysis (HD) patients. Carbonate is the alternate counterion to chloride on the sevelamer polymeric backbone, but the active poly(allylamine) responsible for phosphate (PO₄) binding remains unaltered. Therefore, sevelamer carbonate is expected to reduce elevated serum phosphorus level, similarly to sevelamer hydrochloride. Sevelamers are prescribed in uremic HD patients to control hyperphosphatemia, but the carbonate has also been proposed for the treatment of chronic kidney disease (CKD) non-dialysis patients. Although hyperphosphatemia is regarded as a main contributor to increased mortality in the HD population because of cardiovascular calcification, metabolic acidosis has also been advocated as a major player in the increased mortality in this population, by engendering malnutrition, negative nitrogen balance, and inflammation. This paper reviews the evidence showing that sevelamer carbonate is as good as sevelamer hydrochloride in terms of hyperphosphatemia control in CKD, but with a better outcome in serum bicarbonate balance.
碳酸司维拉姆是一种阴离子交换药物，旨在改善不可吸收、非钙和无金属的磷酸盐结合剂盐酸司维拉姆的性能。与盐酸司维拉姆在血液透析 (HD) 患者中长期治疗时报告的情况不同，预计碳酸司维拉姆不会加重代谢性酸中毒。碳酸根是司维拉姆聚合物主链上氯的替代反离子，但负责结合磷酸盐 (PO₄) 的活性聚 (烯丙胺) 保持不变。因此，碳酸司维拉姆有望降低升高的血清磷水平，与盐酸司维拉姆类似。司维拉姆被开给尿毒症 HD 患者以控制高磷血症，但碳酸盐也被提议用于治疗慢性肾脏病 (CKD) 非透析患者。尽管高磷血症被认为是 HD 人群中因心血管钙化导致死亡率增加的主要因素，但代谢性酸中毒也被认为是该人群死亡率增加的主要因素，因为它会导致营养不良、负氮平衡和炎症。本文综述了证据表明，碳酸司维拉姆在 CKD 中控制高磷血症方面与盐酸司维拉姆一样有效，但在血清碳酸氢盐平衡方面的结果更好。
