Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China.
Nephrology (Carlton). 2012 Sep;17(7):616-20. doi: 10.1111/j.1440-1797.2012.01626.x.
Hyperphosphataemia is almost inevitable in end stage renal disease (ESRD) patients and is associated with increased morbidity and mortality. In this study we examined whether oral activated charcoal (oAC) reduces serum phosphate level in haemodialysis patients.
This was an open-label, prospective, uncontrolled study. One hundred and thirty-five haemodialysis patients were included in this study, with cessation of treatment with any phosphate binders during a 2 week washout period. Patients with serum phosphate levels greater than 5.5 mg/dL during the washout period were included for treatment with oAC. oAC was started at a dose of 600 mg three times per day with meals and was administered for 24 weeks. oAC dose was titrated up during the 24 week period to achieve phosphate control (3.5-5.5 mg/dL). A second 2 week washout period followed the end of oAC treatment.
In the 114 patients who successfully completed the trial, the mean dose of activated charcoal was 3190 ± 806 mg/day. oAC reduced mean phosphate levels to below 5.5 mg/dL, with mean decreases of 2.60 ± 0.11 mg/dL (P < 0.01) and 103 (90.4%) of the patients reached the phosphate target. After the second washout period the phosphate levels increased to 7.50 ± 1.03 mg/dL (P < 0.01). Serum intact parathyroid hormone (iPTH) levels declined from 338.75 ± 147.77 pg/mL to 276.51 ± 127.82 pg/mL (P < 0.05) during the study. oAC had no influence on serum prealbumin, total cholesterol, triglycerides, serum ferritin, haemoglobin or platelet levels and the levels of 1,25-dihydroxyvitamin D were stable during the study.
In this open-label uncontrolled study, oAC effectively controls hyperphosphataemia and hyperparathyroidism in haemodialysis patients. The safety and efficacy of oAC needs to be assessed in a randomized controlled trial.
在终末期肾病（ESRD）患者中，高磷血症几乎是不可避免的，并且与发病率和死亡率的增加有关。在这项研究中，我们研究了口服活性炭（oAC）是否能降低血液透析患者的血清磷水平。
这是一项开放标签、前瞻性、非对照研究。在为期 2 周的洗脱期内停止使用任何磷酸盐结合剂治疗后，将 135 名血液透析患者纳入本研究。在洗脱期内血清磷水平大于 5.5mg/dL 的患者被纳入 oAC 治疗。oAC 起始剂量为 600mg，每日 3 次，随餐服用，并持续 24 周。在 24 周期间，oAC 剂量逐渐增加，以达到磷控制（3.5-5.5mg/dL）。oAC 治疗结束后，再进行为期 2 周的洗脱期。
在 114 名成功完成试验的患者中，活性炭的平均剂量为 3190±806mg/天。oAC 将平均磷水平降低至 5.5mg/dL 以下，平均降低 2.60±0.11mg/dL（P<0.01），103 名（90.4%）患者达到磷目标。第二次洗脱期后，磷水平升高至 7.50±1.03mg/dL（P<0.01）。血清全段甲状旁腺激素（iPTH）水平从 338.75±147.77pg/mL 下降至 276.51±127.82pg/mL（P<0.05）。在研究期间，oAC 对血清前白蛋白、总胆固醇、甘油三酯、血清铁蛋白、血红蛋白或血小板水平没有影响，1,25-二羟维生素 D 水平在研究期间保持稳定。
在这项开放标签非对照研究中，oAC 有效地控制了血液透析患者的高磷血症和甲状旁腺功能亢进症。oAC 的安全性和疗效需要在随机对照试验中进行评估。
