Shima Hideaki, Makino Ryojiro, Hata Kenichiro, Ban Akihiko, Funao Kiyoaki, Sugita Syouzou, Furumitsu Yutaka, Inoue Keisuke, Yoshimoto Mitsuru, Okamura Mikio
Kidney Disease Center, Ohno Memorial Hospital, Osaka, Japan.
Ther Apher Dial. 2014 Jun;18 Suppl 2:13-8. doi: 10.1111/1744-9987.12203.
In 2012, bixalomer was launched as new non-calcium (Ca) containing phosphorus (P) binder, increasing the choices available for the treatment of hyperphosphatemia. In this study, among the maintenance dialysis patients at our hospital, we newly administered bixalomer to 21 patients who were not receiving any P binders, and switched to bixalomer for 13 patients who had been receiving sevelamer hydrochloride and 23 patients who had been receiving lanthanum carbonate. The initial dosage of bixalomer was set as 1500 mg/day for new administration patients and dosage equivalent to that of the previously-used P binder for patients who were switched to bixalomer. The dosage of bixalomer was increased if the effects were insufficient. The serum P, Ca and intact parathyroid hormone concentrations as well as serum pH, HCO3 concentration and base excess were evaluated prior to administering bixalomer, 3 months and 6 months after administering bixalomer. For the group who were newly administered bixalomer, significant reductions in serum P concentrations were seen (P<0.01) and no significant changes were seen in clinical test items that serve as indices for acidosis. For the group who were switched from sevelamer hydrochloride to bixalomer, significant reductions in serum P concentrations were seen (P<0.01) together with significant improvements in acidosis (P<0.01). For the group who were switched from lanthanum carbonate to bixalomer, by increasing the dosage of bixalomer to approximately three times the dosage of lanthanum carbonate, it was possible to maintain post-switch serum P concentrations at almost the same levels as before the switch. Furthermore, there were minor, yet significant improvements in acidosis (P<0.01). From these results, it was shown that bixalomer can be useful treatment alternative in dialysis patients for whom it is necessary to change the P binder due to insufficient management of serum P concentrations or development of acidosis.
2012年，比沙洛美作为一种新型的不含钙（Ca）的磷（P）结合剂上市，增加了高磷血症治疗的可选药物。在本研究中，在我院维持性透析患者中，我们对21例未接受任何磷结合剂的患者新使用了比沙洛美，并将13例正在接受盐酸司维拉姆的患者和23例正在接受碳酸镧的患者换用比沙洛美。新使用比沙洛美的患者初始剂量设定为1500毫克/天，换用比沙洛美的患者剂量设定为与之前使用的磷结合剂等效。如果效果不佳，则增加比沙洛美的剂量。在使用比沙洛美之前、使用后3个月和6个月，评估血清磷、钙和完整甲状旁腺激素浓度以及血清pH、碳酸氢根浓度和碱剩余。对于新使用比沙洛美的组，血清磷浓度显著降低（P<0.01），作为酸中毒指标的临床检测项目无显著变化。对于从盐酸司维拉姆换用比沙洛美的组，血清磷浓度显著降低（P<0.01），同时酸中毒显著改善（P<0.01）。对于从碳酸镧换用比沙洛美的组，通过将比沙洛美剂量增加至碳酸镧剂量的约三倍，可以使换用后血清磷浓度维持在与换用前几乎相同的水平。此外，酸中毒有轻微但显著的改善（P<0.01）。从这些结果可以看出，对于因血清磷浓度管理不善或发生酸中毒而需要更换磷结合剂的透析患者，比沙洛美可能是一种有用的治疗选择。
