透析患者血磷控制的挑战.pptVIP

福斯利诺?特性小结 新型磷结合剂，非钙制剂，对血钙水平无显著影响，不增加钙负荷 对磷的亲和力最高且不受pH值影响1 快速且持续稳定的控磷效果2,3 更少的剂量负荷:控制血磷时每日药片负荷比其它磷结合剂更低4 极低生物利用度，人胃肠道吸收0.002% , 长期治疗(长达6年随访)后，无任何全身性的安全问题，包括肝脏系统、骨及中枢神经系统5 患者长期服用耐受性好2,3 是一种理想的磷结合剂 Autissier V et al. Poster presented at ASN 2005 Hutchison AJ et al. Nephron Clin Pract 2005;100:8–19 Hutchison A , Pratt R. Poster presented at ASN 2005 Hutchison A, Gill M. Poster presented at ERA–EDTA 2006 Persy VP et al. Semin Dial 2006;19:195–9 理想的磷结合剂 对磷有高度的结合力， 不影响钙和PTH水平的调节， 不会被肠道吸收， 没有毒性， 不通过肾脏代谢， 给药方案简单，易于患者服用。 理想的磷结合剂 Kid Int 2009， 75, 906–914 磷结合剂 磷结合剂的比较1 Kid Int 2009， 75, 906–914 磷结合剂的比较2 Kid Int 2009， 75, 906–914 * 概说 * 高磷血症的危害 * * The aim of this slide is to introduce lanthanum, the element. The mean daily dietary intake of lanthanum in the general population has been recorded as 0.003–0.005 mg/day. Reference Joint Food Safety and Standards Group (Food Standards Agency): Food Surveillance Information Sheet. .uk/maff/archive/food/infsheet/1994/no34/table1.htm#Table1 This slide gives further details of the chemical profile of lanthanum. Lanthanum is a trivalent cation with a high affinity for phosphate. Lanthanum phosphate has a very low aqueous solubility (the solubility product for lanthanum phosphate is 2.00 x 10?26). Definition of solubility product: the product of the equilibrium concentrations of the ions in a saturated solution of a salt. NOTE: As per the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines, we refer in this Toolkit to Fosrenol? as a phosphate binder (PO43?, the ion), but assessments of the effectiveness of phosphate binding utilize measurements of serum/urine phosphorus (P, the element). Reference Cetiner ZS, Wood SA, Gammons CH. The aqueous geochemistry of the rare earth elements. Part XIV. The solubility of rare earth element phosphates from 23 to 150oC. Chem Geol 2005;217:147–69. 在一个慢性肾衰（CRF）的动物模型中，给大鼠进行5/6的肾切除后，发现1000mg/kg/天剂量的碳酸镧（524mg/kg/天镧）比同等剂量的盐酸司维拉姆和碳酸钙更快更大程度的减少了尿磷量。说明碳酸镧有更强的磷结合能力。碳酸镧的作用效果和氢氧化铝相似。 * This sl