Yamada Shunsuke, Yoshida Hisako, Taniguchi Masatomo, Tanaka Shigeru, Eriguchi Masahiro, Nakano Toshiaki, Tsuruya Kazuhiko, Kitazono Takanari
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan.
Intern Med. 2012;51(16):2097-104. doi: 10.2169/internalmedicine.51.6814. Epub 2012 Aug 15.
Phosphate binders are used in the treatment of hyperphosphatemia in peritoneal dialysis (PD) patients. An ideal phosphate binder for long-term use must be effective with little or no side effects. We evaluated the long-term efficacy and side effects of lanthanum carbonate (LaC) used in combination with other phosphate binders in PD patients.
The subjects of this retrospective study were 30 PD patients who received LaC at Kyushu University. The effect of LaC on various biochemical parameters (serum phosphate, calcium and parathyroid hormone), daily dose of other phosphate binders, gastrointestinal side effects, and nutritional status were determined during the 24-week treatment. We also evaluated the rate of achievement of the Japanese Society of Dialysis Treatment guidelines for secondary hyperparathyroidism and used multivariate analysis to determine the factors associated with the efficacy of LaC.
LaC (960 ± 412 mg/day) reduced serum phosphate from 6.2 to 5.3 mg/dL. The rate of achievement of the guideline target improved after 24 weeks of LaC treatment. The dose of other phosphate binders and dialysis volume remained unchanged during the treatment. Although 53% of patients experienced at least one gastrointestinal side effect, LaC treatment did not affect the nutritional status, and none of the patients discontinued LaC. Multivariate analysis identified low stature, old age and high baseline total creatinine clearance as significant factors that determine the effectiveness of LaC in PD patients.
Low dose LaC treatment used in combination with other phosphate binders improved serum phosphate control with tolerable gastrointestinal symptoms in PD patients.
磷结合剂用于治疗腹膜透析（PD）患者的高磷血症。一种理想的长期使用的磷结合剂必须有效且副作用少或无副作用。我们评估了碳酸镧（LaC）与其他磷结合剂联合用于PD患者的长期疗效和副作用。
这项回顾性研究的对象是30名在九州大学接受LaC治疗的PD患者。在24周的治疗期间，确定了LaC对各种生化参数（血清磷、钙和甲状旁腺激素）、其他磷结合剂的每日剂量、胃肠道副作用和营养状况的影响。我们还评估了日本透析治疗学会继发性甲状旁腺功能亢进指南的达成率，并使用多变量分析来确定与LaC疗效相关的因素。
LaC（960±412毫克/天）使血清磷从6.2毫克/分升降至5.3毫克/分升。LaC治疗24周后，指南目标的达成率有所提高。治疗期间，其他磷结合剂的剂量和透析量保持不变。尽管53%的患者至少出现过一种胃肠道副作用，但LaC治疗并未影响营养状况，且没有患者停用LaC。多变量分析确定身材矮小、年龄较大和基线总肌酐清除率较高是决定LaC对PD患者有效性的重要因素。
低剂量LaC与其他磷结合剂联合使用可改善PD患者的血清磷控制，且胃肠道症状可耐受。
