Introduction to Sevelamer Hydrochloride and its Clinical Effects
Introduction to Sevelamer Hydrochloride and its Clinical Effects
复制标题
盐酸司维拉姆简介及其临床疗效
DOI：
10.1111/j.1744-9987.2005.00279.x
复制
发表时间：
2005
影响因子：
1.9
通讯作者：
Y. Nishizawà
中科院分区：
文献类型：
--
作者：
H. Tahara;Y. Tsujimoto;T. Shoji;M. Inaba;T. Tabata;Y. Nishizawà
摘要：盐酸司维拉姆（SH）广泛用于治疗维持性血液透析肾衰竭患者的高磷血症。 在本研究中，我们研究了SH单药治疗或与碳酸钙制剂联合给药对服用钙基结合剂的患者的钙（Ca）和磷（P）代谢的临床影响。患者分为三组：（i）从钙基结合剂完全转换为SH（完全转换）;（ii）减少钙基结合剂的剂量，并引入SH（部分转换）;（iii）不减少钙基结合剂的剂量，并引入SH（联合治疗）。我们还研究了引入SH对血脂和甲状旁腺激素（PTH）浓度的影响。两组成功治疗病例数（治疗6个月内达到血清P目标浓度= 5.5 mg/dL和Ca × P乘积目标浓度= 55 mg 2/dL 2）的比较表明，如果尽可能维持钙基结合剂（联合治疗>部分转换>完全转换），达到目标水平的可能性更高。 此外，与治疗前相比，SH治疗显著降低了总胆固醇和非HDL胆固醇浓度，并增加了HDL胆固醇和PTH浓度。这些结果表明，当碳酸钙制剂已在使用时，只要合规性允许，添加SH时不应减少剂量。尽管其对脂质和PTH浓度的有益作用，但使用SH时必须防止PTH浓度过度增加。
Abstract: Sevelamer hydrochloride (SH) is widely used for the treatment of hyperphosphatemia in patients with renal failure who are on maintenance hemodialysis. In this study, we investigated the clinical effects of SH, administered as either monotherapy or combined with a calcium carbonate formulation, on the metabolism of calcium (Ca) and phosphorus (P) in patients who had been taking a Ca‐based binder. Patients were divided into three groups (i): switched completely from a Ca‐based binder to SH (complete switch); (ii) dosage of the Ca‐based binder was reduced, and SH introduced (partial switch); and (iii) dosage of the Ca‐based binder was not reduced and SH introduced (combination therapy). We also examined the effects of the introduction of SH on the lipid profile and parathyroid hormone (PTH) concentration. Comparison between groups of the numbers of successfully treated cases (reaching target concentrations of serum P = 5.5 mg/dL and Ca × P product = 55 mg2/dL2 within 6 months of treatment) showed that the likelihood of reaching target levels was higher if Ca‐based binder was maintained as much as possible (combination therapy > partial changeover > complete changeover). Furthermore, treatment with SH decreased total cholesterol and non‐HDL cholesterol concentrations significantly, and also increased HDL cholesterol and PTH concentrations compared to pre‐treatment. These results suggest that when a calcium carbonate formulation is already in use, as far as compliance allows, the dosage should not be reduced when SH is added. Despite its beneficial effects on the lipid and PTH concentrations, preventing an excessive increase in the PTH concentration is essential when using SH.