Malberti Fabio
Divisione di Nefrologia e Dialisi, Istituti Ospitalieri, Cremona, Italy.
G Ital Nefrol. 2010 Nov-Dec;27 Suppl 52:S47-54.
Hyperphosphatemia is a characteristic feature of chronic kidney disease-mineral and bone disorder (CKD-MBD). Phosphorus excess is an independent risk factor for cardiovascular morbidity and mortality in patients with advanced CKD. The keystones of hyperphosphatemia treatment are reduction of dietary phosphorus, use of phosphate binders, and optimized phosphorus removal via dialysis. Several phosphate binders have been approved for use; all share a common functionality in that they bind phosphorus and reduce the amount absorbed in the gastrointestinal lumen. In the past, treatment with oral phosphate binders was intended to prevent symptomatic secondary hyperparathyroidism. More recently, achieving tighter control of markers associated with abnormal mineral metabolism has become a specific therapeutic objective. This therapeutic shift has been driven by several factors: observational data that link disordered mineral metabolism with adverse clinical outcomes; concern about vascular calcification, which is also associated with adverse outcomes and may correlate with exposure to calcium-based phosphatebinding agents; and, perhaps, the availability of new therapeutic agents. In this article we review the rationale for treatment with oral phosphate binders, discuss evidence that supports the use of the available agents, and suggest an approach for clinical practice.
高磷血症是慢性肾脏病-矿物质和骨异常（CKD-MBD）的一个特征性表现。磷过量是晚期CKD患者心血管发病和死亡的独立危险因素。高磷血症治疗的关键在于减少饮食中的磷摄入、使用磷结合剂以及通过透析优化磷清除。几种磷结合剂已获批使用；它们都具有共同的功能，即结合磷并减少胃肠道内吸收的磷量。过去，口服磷结合剂治疗旨在预防有症状的继发性甲状旁腺功能亢进。最近，更严格地控制与矿物质代谢异常相关的指标已成为一个特定的治疗目标。这种治疗转变受到几个因素的推动：将紊乱的矿物质代谢与不良临床结局联系起来的观察性数据；对血管钙化的担忧，血管钙化也与不良结局相关，且可能与接触钙基磷结合剂有关；或许还有新治疗药物的出现。在本文中，我们回顾口服磷结合剂治疗的基本原理，讨论支持使用现有药物的证据，并提出一种临床实践方法。
