Research Unit, University Hospital Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain.
Clin J Am Soc Nephrol. 2011 Sep;6(9):2272-9. doi: 10.2215/CJN.01650211. Epub 2011 Jul 22.
Hyperphosphatemia and subclinical endotoxemia are important sources of inflammation in HD. Proinflammatory cytokines are strong correlates of soluble CD14 (sCD14) concentrations, an independent predictor of mortality in this population. We evaluated the effects of calcium acetate and sevelamer hydrochloride on serum inflammatory profile, endotoxin concentrations, and sCD14 levels in HD patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Prospective, randomized, open-label, parallel design trial. Fifty-nine stable HD patients, 30 receiving sevelamer, and 29 receiving calcium acetate were evaluated. Serum levels of inflammatory parameters (high-sensitivity C-reactive protein [hs-CRP], TNF-α, interleukin (IL)-1, -6, -10, and -18), as well as endotoxin and sCD14 concentrations, were measured at baseline and after 3 months of therapy.
Serum IL-6 increased in patients receiving calcium acetate, whereas hs-CRP and IL-6 significantly decreased in subjects treated with sevelamer, with IL-10 experiencing a trend to increase (P = 0.052). Serum endotoxin and sCD14 levels did not change after treatment with calcium acetate. However, these parameters decreased by 22.6% and 15.2%, respectively (P < 0.01), in patients receiving sevelamer. Multiple regression analysis showed that variation in serum endotoxin concentrations was the strongest factor associated with IL-6 change, whereas the only variables independently associated with changes in sCD14 levels were the variations in serum IL-6 and endotoxin concentrations.
Administration of the noncalcium phosphate binder sevelamer to maintenance HD patients is associated with a significant decrease in hs-CRP, IL-6, serum endotoxin levels and sCD14 concentrations.
高磷血症和亚临床内毒素血症是 HD 患者炎症的重要来源。促炎细胞因子与可溶性 CD14（sCD14）浓度密切相关，是该人群死亡率的独立预测因子。我们评估了醋酸钙和盐酸司维拉姆对 HD 患者血清炎症谱、内毒素浓度和 sCD14 水平的影响。
设计、设置、参与者和测量：前瞻性、随机、开放标签、平行设计试验。59 例稳定的 HD 患者，30 例接受司维拉姆，29 例接受醋酸钙治疗，评估了他们的情况。在基线和治疗 3 个月后，测量了血清炎症参数（高敏 C 反应蛋白[hs-CRP]、TNF-α、白细胞介素[IL]-1、-6、-10 和 -18）、内毒素和 sCD14 浓度。
接受醋酸钙治疗的患者血清 IL-6 升高，而接受司维拉姆治疗的患者 hs-CRP 和 IL-6 显著降低，IL-10 呈升高趋势（P = 0.052）。醋酸钙治疗后血清内毒素和 sCD14 水平没有变化。然而，接受司维拉姆治疗的患者，这些参数分别降低了 22.6%和 15.2%（P < 0.01）。多元回归分析表明，血清内毒素浓度的变化是与 IL-6 变化相关的最强因素，而与 sCD14 水平变化独立相关的唯一变量是血清 IL-6 和内毒素浓度的变化。
在维持性血液透析患者中使用非钙磷酸盐结合剂司维拉姆治疗与 hs-CRP、IL-6、血清内毒素水平和 sCD14 浓度的显著降低有关。
