司维拉姆和碳酸镧治疗腹膜透析患者高磷血症的疗效和不良反应比较

Comparison of efficacy and adverse effects of sevelamer with lanthanum carbonate on treatment of hyperphosphatemia in patients undergoing peritoneal dialysis

目的:探讨不同非含钙磷结合剂治疗腹膜透析(腹透)患者高磷血症的疗效及不良反应。方法:选取2019年5月至2021年3月上海交通大学医学院附属瑞金医院肾脏内科起始非含钙磷结合剂治疗的腹透高磷血症患者124例,司维拉姆61例,碳酸镧63例,比较两者在治疗前后血磷、血钙、甲状旁腺激素(parathyroid hormone,PTH)、25-羟维生素D、碱性磷酸酶、腹主动脉钙化评分(abdominal aortic calcification score,AACS)等指标的变化。结果:随访至2021年10月底,中位随访时间16.9(9.0,27.2)个月。治疗1、3、6个月时血磷分别为(1.70±0.31)、(1.52±0.24)、(1.60±0.34)mmol/L,较基线[(2.08±0.31)mmol/L]显著下降(P<0.05)。治疗1个月、3个月时碳酸镧组达标率较司维拉姆组更高(27.0%比8.2%,P=0.006;63.5%比39.3%,P=0.007);治疗6个月司维拉姆组PTH水平和25-羟维生素D水平与碳酸镧组差异无统计学意义[324.3(178.1,469.7)ng/L比304.4(165.8,413.3)ng/L,P=0.414;15.01(11.98,22.75)nmol/L比20.02(16.01,27.19)nmol/L,P=0.376];2组治疗前后AACS及心脏瓣膜钙化评分差异无统计学意义;碳酸镧恶心、呕吐等胃肠道不良反应更常见(15.9%比1.6%,P=0.005)。结论:碳酸镧较司维拉姆降磷起效更快、初期血磷达标率更高,但消化道耐受性较差。

Objective To investigate the efficacy and adverse effects of different non-calcium-phosphate binders on the treatment of hyperphosphatemia in patients with end-stage kidney disease undergoing peritoneal dialysis.Methods A total of 124 patients with hyperphosphatemia undergoing peritoneal dialysis who were initially treated with non-calcium-phosphate binders agent were enrolled in the Department of Nephrology,Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from May in 2019 to March in 2021.Among them,61 cases were treated with sevelamer and 63 cases were treated with lanthanum carbonate.Serum phosphorus,serum calcium,parathyroid hormone(PTH),25-OH-VitD,alkaline phosphatase level and abdominal aortic calcification score(AACS)before and after treatment were compared in sevelamer or lanthanum carbonate treated groups,furthermore,the pill burden and cost were evaluated.Results The median follow-up time was 16.9(9.0,27.2)months until the end of October 2021.Serum phosphorus level was(1.70±0.31),(1.52±0.24)and(1.60±0.34)mmol/L at 1st,3rd and 6th month after treatment,respectively,and significantly decreased than baseline[(2.08±0.31)mmol/L,P<0.05].After 1 month and 3 months of treatment,the compliance rate in the lanthanum carbonate treated group was higher than that in the sevelamer treated group(27.0%vs 8.2%,P=0.006;63.5%vs 39.3%,P=0.007);while after 6 months of treatment,there was no significant difference in PTH level and 25-OH-VitD level between sevelam treated group and lanthanum carbonate treated group[324.3(178.1,469.7)ng/L vs 304.4(165.8,413.3)ng/L,P=0.414;15.01(11.98,22.75)nmol/L vs 20.02(16.01,27.19)nmol/L,P=0.376].There were no significant differences in AACS and cardiac valve calcification score between the two groups before and after treatment.Gastrointestinal side effects such as nausea and vomiting were more common in lanthanum carbonate treated group(15.9%vs 1.6%,P=0.005).Conclusions Compared with sevelamer,lanthanum carbonate has a faster dephosphorization effect and higher initial serum phosphorus compliance rate,but the digestive tract tolerance is poor.