Thet Zaw, Win Aung Ko, Pedagogos Eugenie, Beavis Jennifer, Crikis Sandra, Nelson Craig
Department of Nephrology, Western Health, Melbourne, Victoria, Australia.
BMC Nephrol. 2013 Oct 1;14:205. doi: 10.1186/1471-2369-14-205.
Phosphate binders' constituents have alkalotic or acidotic properties and may contribute to acid base balance in haemodialysis patients. This study aimed to investigate the differential effects of phosphate binders on pre-dialysis serum bicarbonate in End Stage Kidney Disease patients on maintenance haemodialysis.
Stable out-patients having satellite haemodialysis for at least 3 months were retrospectively studied for 18 months, excluding those with other medical causes for metabolic acidosis. Blood results were censored for inpatient episodes, at the time of death, renal transplant or dialysis modality change. Multivariable multilevel mixed-effects linear regression was used and five groups of phosphate binders were compared: Group A(Calcium (Ca) and/or Aluminium (Al) binders); B(Sevelamer hydrochloride (SH) alone); C(lanthanum carbonate (LC) alone); D(SH and Ca/Al), E(LC and Ca/Al).
Of 320 patients, 292 were eligible for analysis with a mean follow-up of 15.54 (standard deviation, SD 3.98) months. Similar mean pre-dialysis serum levels of bicarbonate were observed at all 6 month-interval analyses. At 18(th) months, observed mean serum bicarbonate levels in mmol/L were Group B: 21.58 (SD 2.82, P<0.001), C: 23.29 (SD 2.80, P=0.02), D: 21.56 (SD 3.00, P<0.001), and E: 21.29 (SD 3.62, P=0.92) compared with Group A: 22.98 (SD 2.77). Mean serum bicarbonate was related to total SH dose in mmol/L: 22.34 (SD 2.56) for SH <2.5 g/day, 21.61 (SD 2.62) for SH 2.5-4.8 g/day, 21.04 (SD 3.31) for SH >4.8 g/day compared with 22.85 (SD 2.91) for non-users; P-trend<0.001.
Phosphate binders' constituents may contribute to/protect against a predisposition to pre-dialysis metabolic acidosis. This may be dose dependant in patients taking Sevelamer Hydrochloride.
磷结合剂的成分具有碱化或酸化特性，可能有助于维持血液透析患者的酸碱平衡。本研究旨在调查磷结合剂对维持性血液透析的终末期肾病患者透析前血清碳酸氢盐的不同影响。
对至少进行3个月卫星血液透析的稳定门诊患者进行了18个月的回顾性研究，排除那些因其他医学原因导致代谢性酸中毒的患者。在患者住院、死亡、肾移植或透析方式改变时，对血液检测结果进行审查。采用多变量多水平混合效应线性回归，并比较了五组磷结合剂：A组（钙（Ca）和/或铝（Al）结合剂）；B组（仅含碳酸司维拉姆（SH））；C组（仅含碳酸镧（LC））；D组（SH与Ca/Al）；E组（LC与Ca/Al）。
320例患者中，292例符合分析条件，平均随访时间为15.54（标准差，SD 3.98）个月。在所有6个月间隔的分析中，均观察到透析前血清碳酸氢盐的平均水平相似。在第18个月时，观察到的血清碳酸氢盐平均水平（mmol/L）为：B组：21.58（SD 2.82，P<0.001），C组：23.29（SD 2.80，P=0.02），D组：21.56（SD 3.00，P<0.001），E组：21.29（SD 3.62，P=0.92），而A组为：22.98（SD 2.77）。血清碳酸氢盐平均水平与SH总剂量（mmol/L）相关：SH<2.5 g/天时为22.34（SD 2.56），SH 2.5 - 4.8 g/天时为21.61（SD 2.62），SH>4.8 g/天时为21.04（SD 3.31），而非使用者为22.85（SD 2.91）；P趋势<0.001。
磷结合剂的成分可能导致/预防透析前代谢性酸中毒倾向。这在服用碳酸司维拉姆的患者中可能存在剂量依赖性。
