Matsubara M, Unagami H, Totsune K, Sato H, Kikuta Y, Ogawa M, Saito T, Yoshinaga K
Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
ASAIO Trans. 1988 Jul-Sep;34(3):168-71.
Long-term CaCO3 treatment of chronic hemodialysis patients was studied. Single doses of CaCO3 were given to 25 patients, 23 of whom had been receiving Al(OH)3 before the study. When predialysis serum calcium (Ca) rose to greater than 5.5 mEq/L, CaCO3 was reduced and Al(OH)3 was administered again. Eighteen months later, serum phosphate (P) was well controlled, and predialysis serum P was less than 6.5 mg/dl in 14 patients given CaCO3 alone. Alkaline phosphatase (ALP) levels significantly decreased, and serum aluminum was remarkably lowered in patients who had discontinued Al(OH)3. In patients who resumed Al(OH)3, ALP levels rose after Al(OH)3 administration. Although levels of c-PTH did not change in CaCO3 treated patients, six patients with poor control of serum P before the study showed a significant decrease in c-PTH. These data indicate that CaCO3 is an effective P binder that stops the progression of silent osteopathy, presumably caused by oral intake of Al(OH)3, and may ameliorate these changes. However, further effort will be necessary to develop means to control serum Ca, because long-term use of CaCO3 induced hypercalcemia in half the patients.
对慢性血液透析患者进行了碳酸钙长期治疗的研究。给25例患者单次服用碳酸钙，其中23例在研究前一直在服用氢氧化铝。当透析前血清钙（Ca）升至大于5.5 mEq/L时，减少碳酸钙用量并再次给予氢氧化铝。18个月后，血清磷（P）得到良好控制，仅服用碳酸钙的14例患者透析前血清P低于6.5 mg/dl。停用氢氧化铝的患者碱性磷酸酶（ALP）水平显著降低，血清铝明显下降。重新服用氢氧化铝的患者，服用后ALP水平升高。虽然碳酸钙治疗患者的全段甲状旁腺激素（c-PTH）水平没有变化，但研究前血清P控制不佳的6例患者c-PTH显著下降。这些数据表明，碳酸钙是一种有效的磷结合剂，可阻止可能由口服氢氧化铝引起的无症状性骨病进展，并可能改善这些变化。然而，由于长期使用碳酸钙导致一半患者出现高钙血症，因此有必要进一步努力开发控制血清钙的方法。
