用盐酸司维拉姆和碳酸司维拉姆对奶制品和母乳进行预处理，以降低磷酸盐。
Pre-treatment of dairy and breast milk with sevelamer hydrochloride and sevelamer carbonate to reduce phosphate.
机构信息
Department of Pediatric Nephrology,1 and Department of Laboratory Medicine,2 Radboud University Nijmegen Medical Centre, Nijmegen, and Department of Pediatrics,3 Gelre Hospital, Apeldoorn, Netherlands.
出版信息
Perit Dial Int. 2013 Sep-Oct;33(5):565-72. doi: 10.3747/pdi.2012.00063. Epub 2013 May 1.
INTRODUCTION
Young children and infants with chronic kidney disease are at increased risk of hyperphosphatemia because of high intake of dairy products. Hyperphosphatemia leads to metastatic calcifications and an increased risk of cardiovascular complications. Sevelamer is an effective phosphate binder, but for children it has important practical disadvantages: it clogs enteral feeding tubes and can cause gastrointestinal complaints. Pre-treatment of dairy products to reduce their phosphate content might solve those problems.
METHODS
Sevelamer hydrochloride and sevelamer carbonate were suspended in various dairy products (cow's milk, breast milk, baby formula, and tube-feeding formula). Each product was tested with varying concentrations of sevelamer. After suspension, each sample was stored for 10 minutes, allowing the sevelamer to precipitate. The supernatant was decanted and analyzed for pH and for phosphate, calcium, magnesium, potassium, sodium, and chloride content.
RESULTS
We observed a significant decrease in the phosphate content of all tested products. With sevelamer hydrochloride, the phosphate reduction was 48% - 91% in the various products, and with sevelamer carbonate, it was 22% - 87%. The highest effectiveness was found in breast milk. A pH increase was found in all products. With sevelamer hydrochloride, a significant increase in chloride occurred. Notably, a significant decrease in calcium content (-75%) was observed in treated breast milk.
CONCLUSIONS
Pretreatment of a variety of dairy products with either sevelamer hydrochloride or sevelamer carbonate effectively reduced their phosphate content and might avoid troublesome ingestion of sevelamer in children. The change in pH with sevelamer hydrochloride was remarkable, reflecting buffering mechanisms. The reduction in the calcium content of breast milk is a potential concern and should be carefully considered and monitored during clinical use of sevelamer.
简介
由于摄入大量乳制品，患有慢性肾脏疾病的幼儿和婴儿存在高磷血症风险。高磷血症会导致转移性钙化和心血管并发症风险增加。司维拉姆是一种有效的磷结合剂，但对儿童而言，它有重要的实际缺点：它会堵塞肠内喂养管，并引起胃肠道不适。对乳制品进行预处理以降低其磷含量可能会解决这些问题。
方法
将盐酸司维拉姆和碳酸司维拉姆悬浮在各种乳制品（牛奶、母乳、婴儿配方奶粉和管饲配方奶粉）中。每种产品都用不同浓度的司维拉姆进行了测试。悬浮后，每种样品储存 10 分钟，使司维拉姆沉淀。倾析上清液并分析 pH 值以及磷酸盐、钙、镁、钾、钠和氯含量。
结果
我们观察到所有测试产品的磷酸盐含量均显著降低。使用盐酸司维拉姆时，各种产品中的磷酸盐减少了 48% - 91%，而使用碳酸司维拉姆时，减少了 22% - 87%。在母乳中效果最高。所有产品的 pH 值均升高。使用盐酸司维拉姆时，氯含量显著增加。值得注意的是，处理后的母乳中的钙含量显著下降（-75%）。
结论
用盐酸司维拉姆或碳酸司维拉姆预处理各种乳制品可有效降低其磷含量，并可能避免儿童麻烦地摄入司维拉姆。盐酸司维拉姆的 pH 值变化显著，反映了缓冲机制。母乳中钙含量的减少是一个潜在的关注点，在临床使用司维拉姆时应仔细考虑并监测。
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