Jandaghi Elahe, Yarmohammadi Maliheh, Ghorbani Raheb, Jalali Tahereh, Salehani Ali Khadjeh, Khani Peiman Mohammad
Department of Internal Medicine, Semnan University of Medical Sciences, Semnan, Tehran, Iran.
Social Determinant of Health Research Center, Semnan University of Medical Sciences, Semnan, Tehran, Iran.
Int J Prev Med. 2021 Aug 24;12:104. doi: 10.4103/ijpvm.IJPVM_464_19. eCollection 2021.
Chronic kidney disease (CKD) is a life-threatening disease with numerous complications. Hemodialysis (HD) patients are prone to magnesium deficiency due to malnutrition, which can cause cardiovascular complications and increase mortality. The present study aimed to investigate the effects of sevelamer and calcium carbonate, as phosphate binders, on serum levels of magnesium, calcium, and phosphorus in HD patients.
A parallel clinical trial was conducted on 54 patients undergoing HD at Kosar Hospital of Semnan. The inclusion criteria were end-stage renal disease (ESRD), alternative HD treatment for at least 3 months 3 times a week, and serum phosphate levels greater than 4.5 mg/dL. The participants were randomly assigned to two groups of sevelamer (n = 27) and calcium carbonate (n = 27). If the participants were taking a phosphate binder, they were asked to stop it for 3 weeks. Participants in the sevelamer group received 800 mg of sevelamer at most three times a day and those in the calcium carbonate group were treated with 500 mg of calcium carbonate at most 3 times a day. Before and 3 months after the intervention, the serum levels of calcium, magnesium, and phosphorus were measured through the Arsenazo method using the Pars Azmun kit in the Selectra auto-analyzer. Twenty-one patients in the sevelamer group and 22 patients in the calcium carbonate group finished the study.
The results showed that calcium carbonate and sevelamer increased serum magnesium level by 0.20 ( = 0.028) and 0.26 ( = 0.002), on average, which were statistically significant. The administration of calcium carbonate did not significantly change serum calcium levels ( = 0.53), whereas sevelamer reduced serum calcium levels by 0.23 ( = 0.017), on average. This reduction was statistically significant. The results also indicated that none of the calcium carbonate ( = 0.099) and sevelamer ( = 0.543) caused significant changes in serum phosphorus levels. The study findings showed no significant difference between the two groups in terms of changes in the serum levels of magnesium (0.590), calcium (0.116), and phosphorus (0.113).
Both drugs (Sevelamer and calcium carbonate) prevented hypomagnesemia and increased serum magnesium levels, but no significant differences were found in blood levels of calcium, phosphorus, and magnesium compared to the two drugs. Considering the effect of magnesium on cardiovascular diseases, increasing the serum magnesium levels through the administration of calcium carbonate and sevelamer can prevent the likelihood of cardiovascular diseases. However, none of the studied drugs was superior to the other in this regard.
慢性肾脏病（CKD）是一种伴有多种并发症的危及生命的疾病。血液透析（HD）患者由于营养不良容易出现镁缺乏，这可能导致心血管并发症并增加死亡率。本研究旨在探讨作为磷结合剂的司维拉姆和碳酸钙对HD患者血清镁、钙和磷水平的影响。
在塞姆南科索医院对54例接受HD治疗的患者进行了一项平行临床试验。纳入标准为终末期肾病（ESRD）、每周进行3次至少3个月的替代HD治疗以及血清磷水平大于4.5mg/dL。参与者被随机分为司维拉姆组（n = 27）和碳酸钙组（n = 27）。如果参与者正在服用磷结合剂，要求他们停药3周。司维拉姆组的参与者每天最多服用800mg司维拉姆，碳酸钙组的参与者每天最多服用500mg碳酸钙。在干预前和干预3个月后，使用Selectra自动分析仪通过偶氮胂法使用Pars Azmun试剂盒测量血清钙、镁和磷水平。司维拉姆组的21例患者和碳酸钙组的22例患者完成了研究。
结果显示，碳酸钙和司维拉姆平均使血清镁水平分别升高0.20（P = 0.028）和0.26（P = 0.002），具有统计学意义。服用碳酸钙未显著改变血清钙水平（P = 0.53），而司维拉姆平均使血清钙水平降低0.23（P = 0.017）。这种降低具有统计学意义。结果还表明，碳酸钙（P = 0.099）和司维拉姆（P = 0.543）均未引起血清磷水平的显著变化。研究结果显示，两组在血清镁（P = 0.590）、钙（P = 0.116）和磷（P = 0.113）水平变化方面无显著差异。
两种药物（司维拉姆和碳酸钙）均预防了低镁血症并提高了血清镁水平，但与两种药物相比，钙、磷和镁的血水平无显著差异。考虑到镁对心血管疾病的影响，通过服用碳酸钙和司维拉姆提高血清镁水平可预防心血管疾病的发生。然而，在这方面，所研究的药物均不优于另一种。
