Sevelamer worsens metabolic acidosis in hemodialysis patients.

摘要: BACKGROUND: Sevelamer hydrochloride, a major phosphate binder for patients on maintenance hemodialysis (MHD) is associated with reduced serum bicarbonate concentration due to hydrochloric acid release in the gut and binding of short chain fatty acids large intestine. Since metabolic acidosis can be deleterious, study was devised compare time course during treatment sevelamer hydrochloride or calcium carbonate. METHODS: Sixteen well nourished MHD who were excellent clinical conditions achieving target levels blood pressure (BP) hemoglobin (Hb), while protein intake 1.1g/kg body weight (bw), enrolled study. After 2-week washout period, divided into two groups, each consisting eight patients, randomized either 24 weeks followed by carbonate (group A) B). Protein intake, n-protein catabolic rate (nPCR), concentrations calcium, phosphate, x (Ca P) product, bicarbonate, intact parathyroid hormone (iPTH) albumin monitored. Time changes relation long dialytic intervals (48 vs. 72 hr) also investigated. RESULTS: Both effectively controlled Ca P product. During plasma significantly below those sevelamer. Plasma fell within DOQI values administration both group A B, goal which not achieved under administration. interval sevelamer, averaged 17.3 +/- 1.1 mEq/L, whereas it 21.1 0.7 mEq/L (p<0.01). Finally, 24-week caused statistically significant (p<0.05) reduction (0.8 g/dL) concentration, without affecting iPTH. Taken together, these results indicate that worsens acidosis, needs corrected.