de Francisco Angel L M, Belmar Lara, Piñera Celestino, Kislikova María, Seras Miguel, Serrano Mara, Albines Zoila, Sango Cristina, Arias Manuel
Nefrologia. 2014;34(5):617-27. doi: 10.3265/Nefrologia.pre2014.Jul.12527.
This observational study was conducted to investigate the use and effectiveness of calcium acetate/magnesium carbonate (CaMg) in the treatment of hyperphosphataemia in dialysis patients in real-world clinical practice.
120 adult CKD patients on dialysis who received CaMg alone or in combination with other phosphate binders were followed-up for 3-12 months. Serum phosphorus, calcium, magnesium, parathyroid hormone and albumin concentration was measured at baseline and after 3, 6 and 12 months respectively. In addition, CaMg dosage, use of concurrent phosphate binders, vitamin D and cinacalcet was documented. Patients were evaluated in 2 subgroups – CaMg alone (n=79) vs. CaMg + concurrent phosphate binder (n=41).
In both subgroups serum phosphorus levels decreased significantly from baseline at 3, 6 and 12 months of CaMg treatment. The percentage achievement of recommended serum phosphorus targets improved after CaMg initiation. At month 6, a total of 78% were within the Kidney Disease Outcomes Quality Initiative (K/DOQI) target range. Total corrected serum calcium increased during CaMg treatment, but mildly exceeded the upper limit of normal in three patients only. Asymptomatic significant increases in magnesium (p<0.001) were observed in the monotherapy group at 3, 6 and 12 months. A total of 80 patients (67%) experienced episodes of mild hypermagnesaemia (>2.6mg/mL, 1.05mmol/L).
This analysis of current clinical practice shows that – consistent with findings from a randomised controlled trial – CaMg treatment leads to marked improvement in serum phosphorus levels, helping patients in trying to achieve K/DOQI and KDIGO (Kidney Disease Improving Global Outcome) targets.
本观察性研究旨在调查醋酸钙/碳酸镁（CaMg）在实际临床实践中治疗透析患者高磷血症的使用情况及有效性。
对120例接受单独CaMg或与其他磷结合剂联合使用的成年慢性肾脏病透析患者进行了3至12个月的随访。分别在基线以及3、6和12个月后测量血清磷、钙、镁、甲状旁腺激素和白蛋白浓度。此外，记录了CaMg剂量、同时使用的磷结合剂、维生素D和西那卡塞的使用情况。患者被分为两个亚组进行评估，即单独使用CaMg组（n = 79）与CaMg + 同时使用磷结合剂组（n = 41）。
在两个亚组中，CaMg治疗3、6和12个月时，血清磷水平均较基线显著下降。开始使用CaMg后，达到推荐血清磷目标的百分比有所提高。在第6个月时，共有78%的患者血清磷水平在肾脏病预后质量倡议（K/DOQI）目标范围内。CaMg治疗期间总校正血清钙有所升高，但仅3例患者略超过正常上限。在单药治疗组中，3、6和12个月时均观察到镁有无症状的显著升高（p<0.001）。共有80例患者（67%）出现轻度高镁血症发作（>2.6mg/mL，1.05mmol/L）。
本次对当前临床实践的分析表明，与随机对照试验的结果一致，CaMg治疗可使血清磷水平显著改善，有助于患者达到K/DOQI和改善全球肾脏病预后（KDIGO）目标。
