Calcium carbonate as a phosphate binder in patients with chronic renal failure undergoing dialysis.
Calcium carbonate as a phosphate binder in patients with chronic renal failure undergoing dialysis.
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碳酸钙作为接受透析的慢性肾衰竭患者的磷酸盐结合剂。
DOI：
10.1056/nejm198607173150304
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Delmez,J
中科院分区：
文献类型：
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作者：
Slatopolsky,E;Weerts,C;Lopez-Hilker,S;Norwood,K;Zink,M;Windus,D;Delmez,J
含铝的磷酸盐结合剂常用于治疗慢性肾功能衰竭患者的高磷酸盐血症，但铝的蓄积可导致骨软化。为了评价碳酸钙作为替代磷结合剂的疗效，我们研究了20例连续三个周期维持透析的患者。在第1阶段，患者服用氢氧化铝一个月（平均剂量，每天5.6 g;范围，1.5至14.0）。在第二阶段，他们一个月不服用磷酸盐结合剂，在第三阶段，他们服用碳酸钙（Os-Cal）两个月（平均剂量，8.5克/天;范围，2.5 - 17）。第1阶段的平均（±SE）血清钙水平为9.6±0.2毫克/分升;在第2阶段，该值略微下降（至9.3±0.1），在第3阶段增加至10.0±0.2。第1阶段的平均（±SE）血清磷水平为4.8±0.1 mg/dl;第2阶段增加至7.3±0.3 mg/dl，但第3阶段恢复至对照值（4.8±0.2）。20例患者中有6例在第3阶段继续需要氢氧化铝以满意地控制高磷血症，碳酸钙成功地降低了大多数患者的血清磷水平并提高了血清钙水平，从而证实了这种药物可能是传统含铝磷结合剂的满意替代品。长期治疗可能导致转移性钙化等副作用的可能性需要进一步研究。（N Engl J Med 1986;315：157-61.）
Phosphate binders that contain aluminum are frequently prescribed to treat hyperphosphatemia in patients with chronic renal failure, but an accumulation of aluminum can lead to osteomalacia. To evaluate the efficacy of calcium carbonate as an alternative phosphate binder, we studied 20 patients maintained on dialysis during three consecutive periods. In period 1, the patients took aluminum hydroxide for a month (mean dose, 5.6 g per day; range, 1.5 to 14.0). In period 2, they took no phosphate binders for a month, and in period 3, they took calcium carbonate (Os-Cal) for two months (mean dose, 8.5 g per day; range, 2.5 to 17).The mean (±SE) serum calcium level during period 1 was 9.6±0.2 mg per deciliter; this decreased slightly (to 9.3±0.1) during period 2 and increased to 10.0±0.2 during period 3. The mean (±SE) serum phosphorus level during period 1 was 4.8±0.1 mg per deciliter; this increased to 7.3±0.3 during period 2, but returned to the control value (4.8±0.2) during period 3. Six of the 20 patients continued to need aluminum hydroxide during period 3 for satisfactory control of hyperphosphatemia.Calcium carbonate successfully lowered serum phosphorus levels and raised serum calcium levels in the majority of our patients, thereby confirming that this agent may be a satisfactory substitute for traditional phosphate binders that contain aluminum. The possibility that long-term treatment could cause such side effects as metastatic calcification will require further investigation. (N Engl J Med 1986;315:157–61.)