根据餐中磷含量调整磷结合剂剂量可改善慢性肾脏病儿童高磷血症的管理。

Self-adjustment of phosphate binder dose to meal phosphorus content improves management of hyperphosphataemia in children with chronic kidney disease.

机构信息

Department of Paediatric Kidney, Liver and Metabolic Diseases, Medical School of Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.

出版信息

Nephrol Dial Transplant. 2010 Oct;25(10):3241-9. doi: 10.1093/ndt/gfq161. Epub 2010 Mar 22.

DOI:10.1093/ndt/gfq161

PMID:20308040

Abstract

BACKGROUND

Hyperphosphataemia in patients with chronic kidney disease (CKD) is associated with mineral and bone disorder and increased cardiovascular mortality. Despite phosphate binders (PB), nutrition counselling and dialysis therapy, the prevalence of hyperphosphataemia remains unacceptably high. It was hypothesized that an inadequate relation of PB dose to meal inorganic phosphorus (iP) content may be an important factor for failure of phosphate management.

METHODS

The innovative 'Phosphate Education Program' (PEP) bases on patient empowerment to eye-estimate meal iP content by newly defined 'Phosphate Units' (PU; 1 PU per 100 mg phosphorus) and self-adjust PB dosage to dietary iP intake by an individually prescribed PB/PU ratio (PB pills per PU). In a prospective study, 16 children (aged 4-17 years) with CKD and their parents were trained with the PEP concept and followed up for 24 weeks for changes in serum electrolyte levels, dietary behaviour and PB dose.

RESULTS

Within 6 weeks after PEP training, the percentage of children with serum phosphate (PO) >1.78 mmol/l dropped from 63% (10/16) to 31% (5/16). Mean serum PO level decreased from 1.94 ± 0.23 at baseline to 1.68 ± 0.30 (SD) mmol/l in Week 7-12 (P = 0.02) and to 1.78 ± 0.36 (SD) mmol/l in Week 19-24 (P = 0.2), whereas serum calcium [2.66 ± 0.3 vs 2.60 ± 0.23 (SD) mmol/l in Weeks 7-12 (P = 0.45) and 2.66 ± 0.23 (SD) mmol/l in Week 19-24 (P = 0.21)] and serum potassium [4.69 ± 0.48 vs 4.58 ± 0.68 (SD) mmol/l in Week 7-12 (P = 0.40) and 4.65 ± 0.49 (SD) mmol/l in Week 19-24 (P = 0.73)] remained unchanged. The mean daily PB dose rose from 6.3 ± 2.9 to 8.2 ± 5.4 (SD) pills during observation period with an increased meal-to-meal variability (P = 0.04). Dietary iP intake was not affected by PEP concept.

CONCLUSION

The empowerment of children with CKD and their parents to self-adjust PB dose to eye-estimated meal iP content significantly improved management of hyperphosphataemia without reducing dietary iP intake.

摘要

背景

慢性肾脏病（CKD）患者的高磷血症与矿物质和骨代谢紊乱以及心血管死亡率增加有关。尽管使用了磷结合剂（PB）、营养咨询和透析治疗，但高磷血症的患病率仍然高得令人无法接受。有人假设，PB 剂量与膳食无机磷（iP）含量之间的关系不足可能是磷酸盐管理失败的一个重要因素。

方法

创新的“磷酸盐教育计划”（PEP）基于患者赋权，通过新定义的“磷酸盐单位”（PU；每 100 毫克磷 1 个 PU）来估计膳食 iP 含量，并通过个人规定的 PB/PU 比值（每 PU 的 PB 丸数）来调整 PB 剂量以适应膳食 iP 摄入量。在一项前瞻性研究中，对 16 名患有 CKD 的儿童（年龄 4-17 岁）及其父母进行了 PEP 概念培训，并对其血清电解质水平、饮食行为和 PB 剂量进行了 24 周的随访。

结果

PEP 培训后 6 周内，血清磷（PO）>1.78mmol/l 的患儿比例从 63%（10/16）降至 31%（5/16）。血清 PO 水平从基线时的 1.94±0.23mmol/l 降至第 7-12 周的 1.68±0.30（SD）mmol/l（P=0.02）和第 19-24 周的 1.78±0.36（SD）mmol/l（P=0.2），而血清钙[2.66±0.3 与 2.60±0.23（SD）mmol/l 第 7-12 周（P=0.45）和第 19-24 周（P=0.21）]和血清钾[4.69±0.48 与 4.58±0.68（SD）mmol/l 第 7-12 周（P=0.40）和第 19-24 周（P=0.73）]无变化。观察期间，平均每日 PB 剂量从 6.3±2.9 增加到 8.2±5.4（SD）丸，餐间变异性增加（P=0.04）。PEP 概念并未影响膳食 iP 摄入量。