Prospective observational study of sevelamer hydrochloride and lanthanum carbonate-Effect of sevelamer hydrochloride on the acid-base equilibrium of patients on hemodialysis with citric acid dialysate

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  • 塩酸セベラマーと炭酸ランタンの酸塩基平衡に対する効果の前向き研究
  • エンサン セベラマー ト タンサン ランタン ノ サンエンキ ヘイコウ ニ タイスル コウカ ノ マエムキ ケンキュウ

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A state of metabolic acidosis in hemodialysis patients is linked to a frequency of hospitalization and worsening of their survival prognosis, and it has also been reported to have a negative impact on their bone metabolism. We performed a prospective observational study using phosphorus (P) adsorbing agents sevelamer hydrochloride (SH) and lanthanum carbonate (LC) during hemodialysis with a citric acid dialysate (Carbostar®), which contains a large amount of bicarbonic acid. Then we assessed the effect of SH on metabolic acidosis and the P-adsorbing efficacy of both SH and LC. Methods : Forty patients who orally ingested large doses of SH (≥5,250 mg/day) despite diet therapy were randomly assigned to one of 2 groups of 20 patients each, an SH group and an LC group. The groups took their respective P-adsorbing agent orally for 5 weeks, and then both groups took SH orally for 4 weeks. Results : Severe metabolic acidosis (HCO3-≤20 mEq/L), was observed in both groups at baseline despite the use of citric acid dialysate. When the study began, however, there was a gradual tendency for metabolic acidosis to improve in the LC group, and the difference between the two groups was significant from the second week onward (LC group : HCO3- concentration before dialysis after 4 weeks 22.3±2.5 mEq/L ; HCO3- concentration after 5 weeks 23.0±2.0 mEq/L). However, as a result of the change from LC to SH from the 6th week onward, in the 7th week there was rapid deterioration to the baseline metabolic acidosis level. After 5 weeks, 1,500 mg of LC corresponded to approximately 6,500 mg of SH in the LC group. Discussion : We think that it is necessary to bear in mind the progression of metabolic acidosis by SH when treating hyperphosphatemia and to select an appropriate P-absorbing agent.

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