Salusky I B, Foley J, Nelson P, Goodman W G
Department of Pediatrics, UCLA School of Medicine.
N Engl J Med. 1991 Feb 21;324(8):527-31. doi: 10.1056/NEJM199102213240804.
The control of hyperphosphatemia is a major clinical problem in patients with chronic renal failure receiving regular dialysis treatment. Despite continuing concern about aluminum toxicity, aluminum-containing antacids are still used in many of these patients as phosphate-binding agents. Although maximal acceptable doses of aluminum hydroxide have been recommended, the safety and efficacy of these guidelines have not been evaluated.
Seventeen children and young adults (mean [+/- SD] age, 14.1 +/- 3.7 years) undergoing regular peritoneal dialysis were randomly assigned to treatment with either aluminum hydroxide (n = 7; maximal dose, 30 mg per kilogram of body weight per day) or calcium carbonate (n = 10; dose range, 2.5 to 12 g per day, according to serum phosphorus levels). Aluminum retention was assessed by serial measurements of plasma aluminum, deferoxamine-infusion tests, and measurements of bone aluminum content during a mean (+/- SD) follow-up of 13 +/- 2 months. The evolution of bone disease was also evaluated.
Plasma aluminum levels and the increment in plasma aluminum after infusion of deferoxamine increased from base-line values in the patients treated with aluminum hydroxide, and aluminum-related bone disease developed in one patient. Serum phosphorus levels remained higher and serum calcium levels lower in the patients receiving aluminum hydroxide than in those receiving calcium carbonate. The skeletal lesions of secondary hyperparathyroidism improved in 7 of 10 patients receiving calcium carbonate but persisted or progressed in 6 of 7 patients given aluminum hydroxide (P less than 0.025).
Aluminum hydroxide is less effective than calcium carbonate as a phosphate-binding agent for the control of hyperphosphatemia and is associated with aluminum retention in children and young adults with chronic renal failure who are receiving dialysis therapy.
对于接受定期透析治疗的慢性肾衰竭患者，控制高磷血症是一个主要的临床问题。尽管人们一直担心铝中毒，但许多此类患者仍使用含铝抗酸剂作为磷结合剂。虽然已推荐了氢氧化铝的最大可接受剂量，但这些指南的安全性和有效性尚未得到评估。
17名接受定期腹膜透析的儿童和青年（平均[±标准差]年龄为14.1±3.7岁）被随机分配接受氢氧化铝治疗（n = 7；最大剂量为每日每千克体重30毫克）或碳酸钙治疗（n = 10；剂量范围为每日2.5至12克，根据血清磷水平调整）。在平均（±标准差）13±2个月的随访期间，通过连续测量血浆铝、去铁胺输注试验以及测量骨铝含量来评估铝潴留情况。同时也评估了骨病的进展情况。
接受氢氧化铝治疗的患者血浆铝水平以及输注去铁胺后血浆铝的增量均高于基线值，且有1例患者发生了铝相关性骨病。接受氢氧化铝治疗的患者血清磷水平仍高于接受碳酸钙治疗的患者，而血清钙水平则低于后者。接受碳酸钙治疗的10例患者中，有7例继发性甲状旁腺功能亢进的骨骼病变有所改善，而接受氢氧化铝治疗的7例患者中，有6例病变持续存在或进展（P<0.025）。
作为控制高磷血症的磷结合剂，氢氧化铝的效果不如碳酸钙，并且在接受透析治疗的慢性肾衰竭儿童和青年中会导致铝潴留。
