Forfang Derek, Edwards Dawn P, Kalantar-Zadeh Kamyar
National Forum of ESRD Networks Kidney Patient Advisory Council, Burlingame, CA.
National Kidney Foundation Public Policy Committee, New York, NY.
Kidney Med. 2022 Feb 16;4(4):100437. doi: 10.1016/j.xkme.2022.100437. eCollection 2022 Apr.
Patients with kidney failure and early stages of chronic kidney disease often develop hyperphosphatemia, which is associated with negative outcomes. The reduction of phosphate levels is the established clinical practice. However, achieving and maintaining target phosphate levels is challenging, and the current methods of phosphate management lead to poor quality of life (QoL) in patients receiving dialysis, particularly because patients might not receive adequate education on phosphate control. Patients receiving dialysis are advised to maintain stringent dietary restrictions and might experience anxiety and depression due to the constant burden of dietary self-management. The lack of nutritional information on food labels makes adhering to dietary restrictions even more confusing and difficult. Phosphate binders are the only pharmacologic treatment currently indicated for hyperphosphatemia. However, phosphate binders have a limited binding capacity and are difficult to incorporate into patients' daily routines. Because of the suboptimal efficacy of phosphate binders and the negative impact of dietary restrictions on patient QoL, novel therapies for more effective phosphate control are needed. New treatment options that control phosphate levels would enable patients to eat a more normal, healthy diet and potentially improve their QoL.
肾衰竭和慢性肾病早期患者常出现高磷血症,这与不良预后相关。降低磷酸盐水平是既定的临床实践。然而,实现并维持目标磷酸盐水平具有挑战性,并且当前的磷酸盐管理方法导致接受透析的患者生活质量较差,特别是因为患者可能未接受足够的磷酸盐控制教育。建议接受透析的患者保持严格的饮食限制,并且由于持续的饮食自我管理负担,可能会出现焦虑和抑郁。食品标签上缺乏营养信息使得遵守饮食限制更加混乱和困难。磷酸盐结合剂是目前唯一被指定用于治疗高磷血症的药物治疗方法。然而,磷酸盐结合剂的结合能力有限,并且难以融入患者的日常生活。由于磷酸盐结合剂的疗效欠佳以及饮食限制对患者生活质量的负面影响,需要新的更有效的磷酸盐控制疗法。能够控制磷酸盐水平的新治疗选择将使患者能够食用更正常、健康的饮食,并有可能改善他们的生活质量。