Effect of Sevelamer and Calcium-Based Phosphate Binders on Coronary Artery Calcification and Accumulation of Circulating Advanced Glycation End Products in Hemodialysis Patients
Effect of Sevelamer and Calcium-Based Phosphate Binders on Coronary Artery Calcification and Accumulation of Circulating Advanced Glycation End Products in Hemodialysis Patients
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DOI：
10.1053/j.ajkd.2010.10.055
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发表时间：
2011-03-01
影响因子：
13.2
通讯作者：
Saito, Akira
中科院分区：
文献类型：
--
作者：
Kakuta, Takatoshi;Tanaka, Reika;Saito, Akira
背景资料：一些试验表明，接受司维拉姆治疗的透析患者的冠状动脉钙化进展速度比使用钙结合剂的患者慢。磷结合剂对循环晚期糖基化终末产物（AGEs）的影响尚不清楚。研究设计：平行组设计的随机试验。设置和参与者：183名成人（年龄> 20岁）患者在12个透析设施进行维持性血液透析治疗，平均年龄为118 +/- 89（中位数，108）个月。透析液钙浓度为2.5 mEq/L，饮食钙不受控制。干预：患者被随机分配到12个月的治疗与司维拉姆（n = 91）或碳酸钙（n = 92）。主要结果指标为冠状动脉钙化评分（CACS）较基线的变化在研究进入和完成时使用多层计算机断层扫描和CACS增加>= 15%的患者比例确定。血液参数测定在研究进入和2周的时间间隔，血浆戊糖苷，一个代表性的AGE水平，测定在研究进入，6个月，研究completion.Results：79（86.8%）和84（91.3%）例患者在司维拉姆和碳酸钙武器完成了治疗，分别。两种粘合剂均与平均CACS增加相关：分别为81.8（95% CI，42.9-120.6）和194.0（139.7-248.4）（两者均P < 0.001）。调整基线值后，司维拉姆组的增加量减少了112.3（45.8-178）（P < 0.001）。司维拉姆组CACS增加≥ 15%的患者比例为35%，碳酸钙组为59%（P = 0.002）。司维拉姆治疗后血浆戊糖苷水平升高（P < 0.001）。使用司维拉姆与CACS增加>= 15%的风险降低相关，无论基线血液参数、戊糖苷水平和CACS.Limitations：治疗持续时间相对较短，一些司维拉姆治疗的患者（79例中的7例）接受碳酸钙治疗，洗脱期无法进行。结论：数据表明，司维拉姆治疗减缓了CACS的增加，抑制了AGE的积累。美国肾脏病杂志57（3）：422-431。(C)2011年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background: Some trials have indicated that coronary artery calcification progresses more slowly in sevelamer-treated dialysis patients than in those using calcium-based binders. Effects of phosphate binders on circulating advanced glycation end products (AGEs) are unknown.Study Design: Randomized trial with parallel-group design.Setting & Participants: 183 adult (aged > 20 years) patients on maintenance hemodialysis therapy at 12 dialysis facilities with a mean vintage of 118 +/- 89 (median, 108) months. Dialysate calcium concentration was 2.5 mEq/L, and dietary calcium was not controlled.Intervention: Patients were randomly assigned to 12 months of treatment with sevelamer (n = 91) or calcium carbonate (n = 92).Outcomes & Measurements: Primary outcome measures were change from baseline in coronary artery calcification score (CACS) determined at study entry and completion using multislice computed tomography and the proportion of patients with a >= 15% increase in CACS. Blood parameters were determined at study entry and 2-week intervals, and levels of plasma pentosidine, a representative AGE, were determined at study entry, 6 months, and study completion.Results: 79 (86.8%) and 84 (91.3%) patients in the sevelamer and calcium-carbonate arms completed the treatment, respectively. Both binders were associated with an increase in mean CACS: 81.8 (95% CI, 42.9-120.6) and 194.0 (139.7-248.4), respectively (P < 0.001 for both). After adjustment for baseline values, the increase in the sevelamer group was 112.3 (45.8-178) less (P < 0.001). Percentages of patients with a >= 15% increase in CACS were 35% of the sevelamer group and 59% of the calcium-carbonate group (P = 0.002). Plasma pentosidine levels increased with sevelamer treatment (P < 0.001). Sevelamer use was associated with decreased risk of a >= 15% increase in CACS regardless of baseline blood parameters, pentosidine level, and CACS.Limitations: Treatment duration was relatively short, some sevelamer-treated patients (7 of 79) received calcium carbonate, and washout could not be performed.Conclusions: The data suggest that sevelamer treatment slowed the increase in CACS and suppressed AGE accumulation. Am J Kidney Dis. 57(3): 422-431. (C) 2011 by the National Kidney Foundation, Inc.