An update on phosphate binders for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis: a review of safety profiles
An update on phosphate binders for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis: a review of safety profiles
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DOI：
10.1080/14740338.2022.2044472
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发表时间：
2022-02-24
影响因子：
3.1
通讯作者：
Ito, Hidetoshi
中科院分区：
文献类型：
--
作者：
Ogata, Hiroaki;Takeshima, Akiko;Ito, Hidetoshi
高磷血症是透析患者不可避免的并发症，因此需要磷酸盐结合剂治疗。目前，临床上有多种磷酸盐结合剂。除了降低磷酸盐的活性外，单个磷酸盐结合剂具有不同的安全性和脱靶作用。综述了磷酸盐粘合剂的安全性及有待解决的问题。专家意见：钙基磷酸盐粘合剂耐受性良好，但可能增加钙超载的风险。Sevelamer降低血清胆固醇水平并具有抗炎作用。与西维拉默相比，双沙洛默与较少的胃肠道症状相关。含铝粘结剂、碳酸镧和氢氧化铁均表现出较强的降磷活性。虽然柠檬酸铁降低促红细胞生成剂和静脉注射铁剂量，但它的使用需要监测铁代谢标志物，以避免超载。偶尔，多种磷酸盐粘合剂的联合使用可以提供每种磷酸盐粘合剂的优点，同时最大限度地减少其缺点；因此，这可能是可取的根据个别患者的条件和合并症。然而，药片负担增加和对磷酸盐粘合剂的不粘附性成为新的问题。我们期待新的治疗策略能够解决这些问题。
Introduction Hyperphosphatemia is an inevitable complication for patients undergoing dialysis, as is the resulting need for treatment with phosphate binders. Currently, various phosphate binders are clinically available. In addition to their phosphate-lowering activity, individual phosphate binders have differing safety profiles and off-target actions. Areas covered This paper reviews the safety of phosphate binders and issues to be resolved. Expert opinion Calcium-based phosphate binders are well tolerated but may increase calcium overload risk. Sevelamer reduces serum cholesterol levels and exerts anti-inflammatory effects. Compared to sevelamer, bixalomer is associated with fewer gastrointestinal symptoms. Aluminum-containing binders, lanthanum carbonate, and sucroferric oxyhydroxide exhibit strong phosphate-lowering activity. Although ferric citrate reduces erythropoiesis-stimulating agents and intravenous iron doses, its use requires monitoring of iron metabolic markers to avoid overload. Occasionally, combined use of multiple phosphate binders can offer the advantages of each phosphate binder while minimizing their drawbacks; thus, this may be desirable according to individual patients' conditions and comorbidities. However, increased pill burden and nonadherence to phosphate binders emerge as new problems. We expect that novel therapeutic strategies will be developed to resolve these issues.