Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
Blood Purif. 2010;29(4):352-6. doi: 10.1159/000302723. Epub 2010 Mar 31.
Uremic toxins play a pivotal role in the development of systemic complications of chronic kidney disease (CKD), which are largely mediated by the activation of the immune system. Triggers of inflammation in CKD are largely unknown and strategies aiming to reduce circulating ligands that could start the inflammatory response are potentially important. In the present study, we investigated the impact of sevelamer hydrochloride treatment in reducing endotoxemia and inflammation in a group of hemodialysis (HD) patients.
HD patients, who were converted from calcium carbonate treatment to sevelamer according to KDOQI guidelines, were included and prospectively followed for 6 months. Systemic inflammation was evaluated by serum ultra-high-sensitivity C-reactive protein (hsCRP) using an automated immunoturbidimetric assay. Endotoxin was measured using Limulus amebocyte lysate chromogenic endpoint assay. All the analyses were performed immediately before conversion and after 6 months of treatment.
After the exclusion of patients discontinuing the treatment, 20 patients (mean dialysis time 12 +/- 4 months on HD, age 52 +/- 2 years, 38% males, 11% diabetics) were included in the analysis. No significant changes were observed in Ca, P and PTH levels, while a reduction in cholesterol levels was seen. Plasma concentration of hsCRP and endotoxin significantly decreased after 6 months of conversion to sevelamer compared with baseline.
We conclude that sevelamer treatment leads to a decrease in hsCRP levels, which was accompanied by a parallel decrease in endotoxemia, suggesting that endotoxemia may contribute to the systemic inflammation in HD patients, which was partially reduced by the use of sevelamer.
尿毒症毒素在慢性肾脏病（CKD）的全身并发症的发展中起着关键作用，这些并发症主要是通过免疫系统的激活来介导的。CKD 中炎症的触发因素在很大程度上是未知的，而旨在减少可能引发炎症反应的循环配体的策略可能是重要的。在本研究中，我们研究了盐酸司维拉姆治疗在降低一组血液透析（HD）患者的内毒素血症和炎症中的作用。
根据 KDOQI 指南，将接受碳酸钙治疗的 HD 患者转换为盐酸司维拉姆，并进行前瞻性随访 6 个月。使用自动免疫比浊法测定血清超敏 C 反应蛋白（hsCRP）评估全身炎症。使用鲎变形细胞溶解物显色终点法测定内毒素。所有分析均在转换前和治疗 6 个月后立即进行。
在排除停止治疗的患者后，20 名患者（HD 透析时间平均为 12±4 个月，年龄 52±2 岁，男性占 38%，糖尿病患者占 11%）被纳入分析。在用司维拉姆转换后 6 个月，Ca、P 和 PTH 水平没有明显变化，而胆固醇水平降低。与基线相比，转换为司维拉姆后 6 个月，hsCRP 和内毒素的血浆浓度显著降低。
我们的结论是，司维拉姆治疗可导致 hsCRP 水平降低，同时内毒素血症也随之降低，这表明内毒素血症可能导致 HD 患者的全身炎症，而司维拉姆的使用部分减轻了这种炎症。
