Filiopoulos Vassilis, Koutis Ioannis, Trompouki Sofia, Hadjiyannakos Dimitrios, Lazarou Dimitrios, Vlassopoulos Dimosthenis
Nephrology Department, Amalia Fleming General Hospital, Athens, Greece.
Ther Apher Dial. 2011 Feb;15(1):20-7. doi: 10.1111/j.1744-9987.2010.00868.x. Epub 2010 Oct 25.
Sevelamer hydrochloride (SH) has been reported to aggravate metabolic acidosis and hyperkalemia. This study was performed to evaluate acid-base status and serum potassium changes after replacing SH with lanthanum carbonate (LC) in hemodialysis patients. SH was prescribed for 24 weeks in 14 stable hemodialysis patients and replaced by LC in a similar treatment schedule. Laboratory tests, including indices of acid-base status, nutrition, bone/mineral metabolism, and dialysis adequacy, were performed monthly during the study. Dialysate bicarbonate, potassium and calcium concentrations remained constant. Serum bicarbonate and pH rose, and serum potassium dropped significantly under LC. Alkaline phosphatase also decreased significantly under LC. No significant differences were observed in the other studied parameters between the two treatment periods. Control of serum phosphate was similar under both phosphate-binders and no differences were observed in calcium, Ca × P product, CRP, or lipid levels. Dialysis adequacy was constantly kept within K/DOQI target-range. Although full compliance to treatment was reported, three patients on LC complained of gastrointestinal upset and/or a metallic taste, and four had difficulty chewing the LC tablet. LC improves metabolic acidosis and hyperkalemia in hemodialysis patients previously under SH. Although both medications are well-tolerated, the gastrointestinal side-effects appear to occur more frequently with LC; a fact that, together with difficulties in chewing the tablet, may result in decreased compliance.
据报道，盐酸司维拉姆（SH）会加重代谢性酸中毒和高钾血症。本研究旨在评估血液透析患者中用碳酸镧（LC）替代SH后酸碱状态和血清钾的变化。14例稳定的血液透析患者接受SH治疗24周，然后以类似的治疗方案换用LC。研究期间每月进行实验室检查，包括酸碱状态、营养、骨/矿物质代谢和透析充分性指标。透析液中碳酸氢盐、钾和钙的浓度保持不变。在LC治疗下，血清碳酸氢盐和pH值升高，血清钾显著下降。碱性磷酸酶在LC治疗下也显著降低。两个治疗阶段之间在其他研究参数上未观察到显著差异。两种磷结合剂对血清磷的控制相似，钙、钙磷乘积、CRP或血脂水平无差异。透析充分性一直保持在K/DOQI目标范围内。尽管报告了对治疗的完全依从性，但3例接受LC治疗的患者抱怨有胃肠道不适和/或金属味，4例患者咀嚼LC片剂有困难。LC可改善先前接受SH治疗的血液透析患者的代谢性酸中毒和高钾血症。尽管两种药物耐受性都良好，但LC的胃肠道副作用似乎更频繁出现；这一事实，连同咀嚼片剂的困难，可能导致依从性降低。
