Di Iorio Biagio, Cucciniello Emanuele
Unità Operativa Complessa di Nefrologia, PO "A Landolfi", ASL Avellino - Solofra (AV), Italy.
Clin Pharmacol. 2010;2:89-93. doi: 10.2147/CPAA.S10218. Epub 2010 Jun 1.
Lanthanum carbonate is an efficacious noncalcium, nonresin phosphate-binder that is being increasingly used in chronic kidney disease stage 5 (CKD-5) dialysis patients. Available evidence has indicated that QT interval changes correlate with mortality in healthy subjects and in dialysis patients. Experimental studies have suggested the possibility that lanthanum carbonate may produce prolongation of the QT interval. This is not accepted by other authors. There is no data confirming this in prospective clinical studies. The goal of this study was to verify the effect of lanthanum carbonate on the QT interval of the electrocardiogram (EKG) tracing.
We studied 25 hemodialyzed patients. After a six-month run-in period, with aluminum-hydroxide, lanthanum carbonate was administered at increasing doses: 500 mg twice a day for week 1; 750 mg, twice daily during week 2; 1000 mg twice daily during week 3; and 1000 mg three times daily during week 4. EKGs were recorded on patients prior to and 3 hours following each dialysis treatment. Assessments were made of differences in body weight; systolic blood pressure; diastolic blood pressure; length of PR and QRS complex; heart rate; QT; QT-c; QT-d; and axis of wave P, QRS complex and T using lanthanum carbonate at increasing doses.
QT-c is before dialysis session during run-in 431 ± 20 msec with variation by -9 to + 1 msec (P = not significant [NS]) during lanthanum use; and 437 ± 25 msec after dialysis session with variation by -6 to -1 msec (P = NS) during lanthanum use. Any difference was observed during study among before and after dialysis session in QT-c (difference by 0.09 to 3.2%) (P = NS); and QT-d (difference by 8.6 to 9.1%) (P = NS).
Our study shows that lanthanum carbonate administration, at increasing doses, did not modify the EKG parameters. This effect is observed both in predialysis and in postdialysis recordings. Further studies are necessary with more prolonged observations.
碳酸镧是一种有效的非钙、非树脂磷酸盐结合剂，越来越多地用于慢性肾脏病5期（CKD-5）透析患者。现有证据表明，QT间期变化与健康受试者和透析患者的死亡率相关。实验研究提示了碳酸镧可能导致QT间期延长的可能性。但其他作者并不认同这一点。在前瞻性临床研究中尚无数据证实这一点。本研究的目的是验证碳酸镧对心电图（EKG）QT间期的影响。
我们研究了25例血液透析患者。在使用氢氧化铝进行为期6个月的导入期后，给予递增剂量的碳酸镧：第1周每天2次，每次500mg；第2周每天2次，每次750mg；第3周每天2次，每次1000mg；第4周每天3次，每次1000mg。在每次透析治疗前及治疗后3小时记录患者的心电图。使用递增剂量的碳酸镧评估体重、收缩压、舒张压、PR和QRS波群长度、心率、QT、QT-c、QT-d以及P波、QRS波群和T波电轴的差异。
导入期透析前QT-c为431±20毫秒，使用碳酸镧期间变化为-9至+1毫秒（P=无显著差异[NS]）；透析后为437±25毫秒，使用碳酸镧期间变化为-6至-1毫秒（P=NS）。在研究期间，透析前后QT-c（差异为0.09%至3.2%）（P=NS）和QT-d（差异为8.6%至9.1%）（P=NS）均未观察到任何差异。
我们的研究表明，递增剂量给予碳酸镧并未改变心电图参数。在透析前和透析后记录中均观察到这种效应。需要进行更长时间观察的进一步研究。
