Torregrosa Prats J V, Mas Mas M, Montesinos Ballestena M, Casellas Bartumeus J, Campistol Plana J M
Unidad Trasplante Renal, Hospital Clinic, Universidad de Barcelona.
An Med Interna. 1995 Aug;12(8):377-81.
In this study, we prospectively evaluated the efficacy of calcium acetate in patients with chronic renal insufficiency on hemodialysis programme with secondary hyperparathyroidism and hyperphosphatemia, which are difficult to control by means of the usual finders (calcium carbonate and aluminium hydroxide) and who were treated with pulses of calcitriol. We studied 10 patients. The inclusion criteria were: a serum phosphorus higher than 6.5 mg/dl, a serum PTHi higher than 250 pg/ml and a serum calcium higher than 9.5. The former therapy was stopped at the time of the patient was included in the study. Calcium acetate was initially introduced with doses between 2.5-4 g/day according to previous calcium and phosphate values. Also, all patients were initially treated with intermittent subcutaneous bolus of Calcitriol were modified and adjusted according to serum concentrations of calcium, phosphorus and PTHi. The concentration of calcium in the dialyzed was of 1.25 mmol/l. Fortnightly total calcium, phosphate and alkaline phosphatase serum determinations and monthly aluminium and PTHi serum determinations were carried out. During the 6 months treatment, a decrease was observed in serum concentrations of phosphate (p < 0.01), aluminum (p < 0.02) and PTHi (p < 0.001) with no changes in the values of calcium (p = ns) nor alkaline phosphatase (p = ns). The incidence of hypercalcemia was low during the follow-up period (11% of all biochemical serum determinations) and was easily controlled. We can conclude that calcium acetate is a sure and effective finder of phosphorus with a very good tolerance. Administered together with pulses of calcitriol, and the use of a low calcium concentration in the dialysate, it does not increase the risk of hypercalcemia.
在本研究中，我们前瞻性评估了醋酸钙对慢性肾功能不全且接受血液透析治疗、伴有继发性甲状旁腺功能亢进和高磷血症患者的疗效。这些患者难以通过常用药物（碳酸钙和氢氧化铝）控制病情，且接受过骨化三醇冲击治疗。我们研究了10名患者。纳入标准为：血清磷高于6.5mg/dl、血清甲状旁腺激素免疫反应性（PTHi）高于250pg/ml以及血清钙高于9.5。患者纳入研究时停用先前的治疗。根据之前的钙和磷值，最初给予醋酸钙的剂量为每日2.5 - 4g。此外，所有患者最初均接受骨化三醇间歇性皮下推注治疗，并根据血清钙、磷和PTHi浓度进行调整。透析液中的钙浓度为1.25mmol/l。每两周进行一次血清总钙、磷和碱性磷酸酶测定，每月进行一次血清铝和PTHi测定。在6个月的治疗期间，观察到血清磷（p < 0.01）、铝（p < 0.02）和PTHi（p < 0.001）浓度降低，而钙值（p = 无显著差异）和碱性磷酸酶（p = 无显著差异）无变化。随访期间高钙血症的发生率较低（占所有生化血清测定的11%），且易于控制。我们可以得出结论，醋酸钙是一种可靠且有效的磷结合剂，耐受性良好。与骨化三醇冲击治疗联合使用，以及在透析液中使用低钙浓度，不会增加高钙血症的风险。
