투석 환자에서 고인산혈증 치료를 위한 경구용인산염 결합제의 임상결과 비교 연구
Comparative Study of Oral Phosphate Binders for the Management of Hyperphosphatemia in Dialysis Patient
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Hyperphosphatemia, one complication of the end stage renal disease (ESRD), maylead to bone disorders and cardiovascular complications (CVD). The management of hyperphosphatemiatreatment needs dietary restrictions and the initiation of oral phosphate binders. Moststudies have evaluated the degrees of vascular calcification (VC) by examining the changes inserum calcium levels and also the ability to control serum mineral levels between the calciumbasedphosphate binders and non calcium-based ones in dialysis patients. The goal of this studyis to compare the clinical results after administering three oral phosphate binders such as calciumacetate, sevelamer hydrochloride, and lanthanum carbonate. We have retrospectively examined100 out of 222 dialysis patients with electronic medical record (EMR) from 2005 to 2012based on the inclusion criteria. The EMR data consist of mineral levels, bone and cardiovascular bio-markers from the baseline to 12 weeks. According to our results, all phosphate binders havesignificantly decreased serum phosphorus levels after 12 weeks (p<0.05). The serum calcium levelsassociated with VC are not statistically significant differences in each of the three groups(p>0.05). The concentrations of alkaline phosphatase (ALP) associated with bone disorders haveincreased, although not statistically significant, during the sevelamer and lanthanum treatment. In the sevelamer treated group, the total cholesterol and low density lipoprotein concentrationshave decreased significantly (p<0.05). Larger and prospective studies associated with the preventionsof CVD in dialysis patients are necessary in the future.
Abstract
Hyperphosphatemia, one complication of the end stage renal disease (ESRD), maylead to bone disorders and cardiovascular complications (CVD). The management of hyperphosphatemiatreatment needs dietary restrictions and the initiation of oral phosphate binders. Moststudies have evaluated the degrees of vascular calcification (VC) by examining the changes inserum calcium levels and also the ability to control serum mineral levels between the calciumbasedphosphate binders and non calcium-based ones in dialysis patients. The goal of this studyis to compare the clinical results after administering three oral phosphate binders such as calciumacetate, sevelamer hydrochloride, and lanthanum carbonate. We have retrospectively examined100 out of 222 dialysis patients with electronic medical record (EMR) from 2005 to 2012based on the inclusion criteria. The EMR data consist of mineral levels, bone and cardiovascular bio-markers from the baseline to 12 weeks. According to our results, all phosphate binders havesignificantly decreased serum phosphorus levels after 12 weeks (p<0.05). The serum calcium levelsassociated with VC are not statistically significant differences in each of the three groups(p>0.05). The concentrations of alkaline phosphatase (ALP) associated with bone disorders haveincreased, although not statistically significant, during the sevelamer and lanthanum treatment. In the sevelamer treated group, the total cholesterol and low density lipoprotein concentrationshave decreased significantly (p<0.05). Larger and prospective studies associated with the preventionsof CVD in dialysis patients are necessary in the future.
참고문헌 (23)
- Nitta K., "Vascular calcification in patients with chronic kidney disease", Ther. Apher Dial, 15, pp.513~521 (2011)
- Tonelli M., "Oral phosphate binders in patients with kidney failure", Engl J Med, 362(14), pp.1312~1324 (2010)
- London G., "The new kidney disease:improving global outcomes (KDIGO) guidelines-expert clinical focus on bone and vascular calcification", Clin Nephrol, 74(6), pp.423~432 (2010)
- "요양급여의 적용기준 및 방법에 관한 세부사항(약제) 개정고시(보건복지부 고시 제 2006-118호, 07.1.1 시행)", 건강보험심사평가원[URL]
- "요양급여의 적용기준 및 방법에 관한 세부사항(약제) 개정고시(보건복지부 고시 제2008-82호, 2008.8.1 시행)", 건강보험심사평가원[URL]
- Mohammed I., "Oral phosphate binders for the management of serum phosphate levels in dialysis patients", J. Ren. Care, 35, pp.65~70 (2009)
- Mason M.A., "Evaluation of morbidity and mortality data related to cardiovascular calcification from calcium-containing phosphate binder use in patients undergoing hemodialysis", Pharmacotherapy, 30, pp.741~748 (2010)
- Iimori S., "Effects of sevelamer hydrochloride on mortality, lipid abnormality and arterial stiffness in hemodialyzed patients:a propensity-matched observational study", Clin. Exp. Nephrol, 16, pp.930~938 (2012)
- Toussaint N. D., "Attenuation of aortic calcification with lanthanum carbonate versus calciumbased phosphate binders in hemodialysis: A pilot randomized controlled trial", Nephrology, 16, pp.290~298 (2011)
- St Peter W. L., "A comparison of sevelamer and calciumbased phosphate binders on mortality, hospitalization, and morbidity in hemodialysis :a secondary analysis of the Dialysis Clinical Outcomes Revisited (DCOR) randomized trial using claims data", Am. J. Kidney, 51, pp.445~454 (2008)
- Koizumi M., "Treatment of hyperphosphatemia with sevelamer hydrochloride in CKD patients: effects on vascular calcification and mortality", Clin Calcium, 20, pp.1700~1708 (2010)
- Shantouf R. S., "Total and individual coronary artery calcium scores as independent predictors of mortality in hemodialysis patients", Am. J. Nephrol, 31, pp.419~425 (2010)
- Jamal S. A., "The effects of calcium-based versus noncalcium-based phosphate binders on mortality among patients with chronic kidney disease: a meta-analysis", Nephrol. Dial Transplant, 24, pp.3168~3174 (2009)
- Zhang Q., "Meta-analysis comparing sevelamer and calcium-based phosphate binders on cardiovascular calcification in hemodia-lysis patients", Nephron. Clin. Pract, 115, pp.259~267 (2010)
- 고영선, "고인산혈증을 동반한 혈액 투석 환자에서 란타늄과 칼슘제재의 효과 비교", Kidney Research and Clinical Practice, 29(1), pp.64~72 (2010), 대한신장학회
- H. W. Kim., "Comparison of sevelamer hydrochloride and aluminum hydroxide in the treatment of hyperphosphatemia in peritoneal dialysis patients. M.S", pp.2004
- Ketteler M., "Phosphate metabolism in CKD stage 3-5:dietary and Pharmacological control", Int J Nephrol, pp.1~6 (2011)
- Block G. A., "Effects of phosphate binders in moderate CKD", J Am Soc Nephrol, 8, pp.1407~1415 (2012)
- Delmas P.D., "Biochemical markers of bone turnover in paget's disease of bone", J. Bone Miner. Research, 14, pp.66~69 (1999)
- Malluche H.H., "lmprovements in renal osteodystropy in patients treated with lanthanum carbonate for two years", Clin. Nephrol, 70, pp.284~295 (2008)
- Bervotes A. R., "Useful biochemical markers for diagnosing renal osteodystropy in predialysis end stage renal failure patients", Am. J. Kidney. Dis, 41, pp.997~1007 (2003)
- Filiopoulos V., "Lanthanum Carbonate Versus Sevelamer Hydrochloride: Improvement of Metabolic Acidosis and Hyperkalemia in Hemodialysis Patients", Ther. Apher. Dial, 15, pp.20~27 (2011)