Gen Shikou, Sasaki Takaya, Saito Kanako, Nobe Kanako, Nodaira Yuka, Ikeda Naofumi
Department of Nephrology, Saitama Sekishinkai Hospital, Saitama, Japan.
Ther Apher Dial. 2014 Jun;18 Suppl 2:8-12. doi: 10.1111/1744-9987.12228.
It has been reported that sevelamer hydrochloride, which is often used as a polymer phosphorus (P) binder for managing serum P concentration in dialysis patients, causes gastrointestinal adverse effects such as constipation, etc. The reason for this is thought to be that sevelamer hydrochloride has high water absorption, causing it to absorb water and swell in the gastrointestinal tract. In June 2012, the new polymer P binder bixalomer was launched in Japan. Since bixalomer has low swelling due to water absorption, it can be expected to alleviate adverse effects in the gastrointestinal system. In our study, for 21 cases of maintenance hemodialysis patients undergoing treatment with sevelamer hydrochloride at our hospital, the P binder was switched from sevelamer hydrochloride to the same dosage of bixalomer, and the concentrations of serum P, corrected calcium (Ca) and whole parathyroid hormone (PTH) before and one month after the switch were compared. In addition, gastrointestinal symptoms (acid reflux, abdominal pain, indigestion, diarrhea and constipation) were evaluated before and after the switch using a questionnaire based on the Japanese version of the Gastrointestinal Symptom Rating Scale (GSRS). By switching to bixalomer, serum P concentration was significantly reduced (P=0.024), but there were no significant changes observed for serum corrected Ca and whole PTH. Furthermore, there were no significant changes observed for all five of the evaluation items of the GSRS, before and after the switch. These results suggest that although bixalomer can more potently reduce the serum P concentration than sevelamer hydrochloride, there were no significant differences in the effects of both P binders on the gastrointestinal symptoms.
据报道，盐酸司维拉姆常作为一种聚合物磷（P）结合剂用于控制透析患者的血清磷浓度，它会引起诸如便秘等胃肠道不良反应。其原因被认为是盐酸司维拉姆吸水性强，导致它在胃肠道内吸水膨胀。2012年6月，新型聚合物磷结合剂比沙洛美在日本上市。由于比沙洛美吸水后膨胀性低，有望减轻胃肠道系统的不良反应。在我们的研究中，对于我院21例接受盐酸司维拉姆治疗的维持性血液透析患者，将磷结合剂从盐酸司维拉姆换为相同剂量的比沙洛美，并比较换药前及换药后1个月时的血清磷、校正钙（Ca）和全段甲状旁腺激素（PTH）浓度。此外，使用基于日本版胃肠道症状评定量表（GSRS）的问卷对换药前后的胃肠道症状（反酸、腹痛、消化不良、腹泻和便秘）进行评估。换用比沙洛美后，血清磷浓度显著降低（P = 0.024），但血清校正钙和全段PTH未观察到显著变化。此外，GSRS的所有五项评估指标在换药前后均未观察到显著变化。这些结果表明，尽管比沙洛美比盐酸司维拉姆能更有效地降低血清磷浓度，但两种磷结合剂对胃肠道症状的影响无显著差异。
