Mohamed Koya Saiful Nizam Mv
Department of Specialist Pharmacy, Jerantut Hospital, Pahang, Malaysia.
Saudi J Kidney Dis Transpl. 2019 May-Jun;30(3):670-677. doi: 10.4103/1319-2442.261343.
Studies have shown that the mean or median phosphate levels were related to certain factors although applying this finding into the clinical setting is challenging. In this study, we attempted to determine treatment characteristics for patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) having hyperphosphatemia or hypophosphatemia in comparison with those with normal phosphate level. This was a cross-sectional survey conducted at HD units of Central Pahang Cluster Hospitals, Malaysia, in April 2017 involving 110 ESRD patients on MHD. About 40% of the study patients had normo-or hyperphosphatemia. As many as 84.5% (n = 93) of our patients were prescribed calcium carbonate (CC); the phosphate level was not affected by phosphate binder (PB) adherence. None of our patients received more than one type of PBs. Although there were no significant differences in any factors between normo- and hyperphosphatemic patients, 64% (n = 28) of the hyperphosphatemic patients did not receive the recommended maximum PB dose. In addition, 42% (n = 30) of patients with normo- and hyperphosphatemia prescribed CC received more than the recommended daily elemental calcium. On the other hand, our hypophosphatemic patients tended to be significantly older and had lower HD duration compared to normophosphatemic patients. No other significant differences were found in medication factors between normo- and hypophos-phatemic patients. There is potential to maximize phosphate control in hyperphosphatemic patients in Malaysia by maximizing PB therapy. On the other hand, proactive supervision is required in caring and prescribing for hypophosphatemic patients, especially the older patients.
研究表明，尽管将这一发现应用于临床环境具有挑战性，但磷酸盐的平均或中位数水平与某些因素相关。在本研究中，我们试图确定维持性血液透析（MHD）的终末期肾病（ESRD）患者出现高磷血症或低磷血症时的治疗特征，并与磷酸盐水平正常的患者进行比较。这是一项于2017年4月在马来西亚彭亨州中部集群医院的血液透析科室进行的横断面调查，涉及110例接受MHD的ESRD患者。约40%的研究患者患有正常磷血症或高磷血症。多达84.5%（n = 93）的患者被处方碳酸钙（CC）；磷酸盐水平不受磷酸盐结合剂（PB）依从性的影响。我们的患者中没有人接受超过一种类型的PBs。尽管正常磷血症和高磷血症患者在任何因素上均无显著差异，但64%（n = 28）的高磷血症患者未接受推荐的最大PB剂量。此外，在处方CC的正常磷血症和高磷血症患者中，42%（n = 30）的患者摄入的每日元素钙超过了推荐量。另一方面，与正常磷血症患者相比，我们的低磷血症患者往往年龄更大，血液透析时间更短。在正常磷血症和低磷血症患者之间，未发现其他药物因素方面的显著差异。在马来西亚，通过最大化PB治疗，有可能使高磷血症患者的磷酸盐控制达到最佳。另一方面，对于低磷血症患者，尤其是老年患者，在护理和开药方面需要进行积极的监督。
