CKD-MBD慢性肾脏病矿物质及骨代谢异常学习资料课件.pptVIP

. . . . Phosphate Binders: Summary Phosphate binders play an important role in managing hyperphosphatemia, typically reducing serum phosphorus by 2 mg/dL. This slide summarizes the advantages and disadvantages of the different types of phosphate binders, but there remains no evidence that these agents differ in their impact on outcomes. Aluminum-containing phosphate binders are highly effective, but they accumulate in patients.1 High systemic aluminum levels cause anemia, and also impact bone matrix mineralization to cause osteomalacia. High levels in the central nervous system have been associated with encephalopathy. Calcium-containing phosphate binders are widely used, but are less potent than aluminum hydroxide, thus necessitating use of large numbers of tablets.1 These agents carry risk of hypercalcemia and progressive vascular calcification. Sevelamer and lanthanum carbonate do not contain either aluminum or calcium.1,2 Sevelamer is as effective as the calcium salts in reducing serum phosphorus, but is associated with lower risk of hypercalcemia and vascular calcification. In addition, sevelamer has favorable effects on serum lipid levels. Lanthanum carbonate appears to be as potent as the aluminum salts as a phosphate binder, but it is minimally absorbed. It is not associated with hypercalcemia.1 Both lanthanum carbonate and sevelamer cost more than the calcium salts. References: 1. Ritz E. The clinical management of hyperphosphatemia. J Nephrol. 2005;18:221-228. 2. Goodman WG. Medical management of secondary hyperparathyroidism in chronic renal failure. Nephrol Dial Transplant. 2003;18(Suppl 3):iii2-iii8. Slide: Cannata-Andia JB, Rodriguez-Garcia M. Hyperphosphataemia as a cardiovascular risk factor – how to manage the problem. Nephrol Dial Transplant. 2002;17(Suppl 11):16-19. . . . . . . . . . . . . . Hyperparathyroidism caused by renal failure. There are signs of bone resorption at the level of the acromioclavicular joint and at the insertion of the co