Проблема кальция в фосфатсвязывающей терапии минерально-костных нарушений при хронической болезни почек у больных, получающих лечение программным гемодиализом


С.Е. Хорошилов

Отделение гемодиализа ФГКУ «Главный военный клинический госпиталь им. акад. Н.Н. Бурденко» Минобороны России, Москва
Обсуждаются факторы риска и патогенез сосудистой кальцификации при хронической болезни почек ХБП. Представлены подходы к терапевтической коррекции нарушений фосфорно-кальциевого метаболизма при ХБП, в т.ч. сравнение клинической и прогностической эффективности фосфат-байндеров.

Литература



  1. Levey A.S., Coresh J. Chronic kidney disease. Lancet. 2012; 379: 165–80.

  2. U.S. Renal Data System: USRDS 2002 Annual Data Report. Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2002.

  3. Шутов Е.В. Нутритивный статус у больных с хронической почечной недостаточностью. Нефрология и диализ. 2008; № 3–4 (Т. 10): 199–207.

  4. Бикбов Б.Т., Томилина Н.А. Состояние заместительной терапии больных с хронической почечной недостаточностью в Российской Федерации в 1998–2009 гг. (отчет по данным Российского регистра заместительной почечной терапии). Нефрология и диализ. 2011; 13(3): 150–264.

  5. Земченков А. Ю., Томилина Н. А. «K/ДОКИ» обращается к истокам хронической почечной недостаточности (О новом разделе Рекомендаций K/DOQI по диагностике, классификации и оценке тяжести хронических заболеваний почек). Нефрология и диализ.2004; № 3 (Т. 6): 204–220.

  6. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Am J Kidney Dis. 2003; 42(suppl 3): 1–202.

  7. The treatment of heart failure. The Task Force of Working Group on Heart Failure of European Society of Cardiology. Eur Heart J. 1997; 18: 736–753.

  8. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000; 342: 145–153.

  9. Хорошилов С.Е., Никитин А.В., Очиченко Т.Ю. Опыт лечения тяжелых нарушений фосфорно-кальциевого обмена при терминальной почечной недостаточности с использованием цинакалцета. Лечащий Врач. 2010; 1: 2–7.

  10. Goodman W.G., Goldin J., Kuizon B.D. Coronary-artery calcification in young adults with end-stage renal disease who are undergouing dialysis. N Engl J Med. May 18 2000; 342(20): 1478–1483.

  11. Гранкин В.И., Новосельцев И.Л., Новицкий Л.В. и др. Диагностика и лечение нарушений фосфорно-кальциевого обмена и вторичного гиперпаратиреоза у больных с терминальной почечной недостаточностью: Методические указания. М., ГВКГ им. Н.Н. Бурденко. 2005.

  12. Ермоленко В.М. Фосфорно-кальциевый обмен и почки. Нефрология: Руководство для врачей. М., Медицина. 2000: 62–75.

  13. Новиков А.И. Современный взгляд на патогенез гиперпаратиреоза при почечной недостаточности как на проблему роста отдельных клонов паращитовидной железы. Практическая нефрология. 1998; 2: 27–36.

  14. Qunibi W.Y., Goldin J., Kuizon B.D. Coronary calcification in patients with end-stage renal disease: A century-old phenomenon. Kidney Int Suppl. Dec 2002(82): 73–80.

  15. Jono S., McKee M.D., Murry C.E. et al. Phosphate regulation of vascular smooth muscle cell calcifi cation. Circ Res. 2000; 87: E10–17.

  16. Levin A., Bakris G.L., Molitch M. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007; 71(1): 31–38.

  17. Miyamoto K., Tatsumi S., Segawa H. et al. Regulation of PiT-1, a sodium-dependent phosphate co-transporter in rat parathyroid glands. Nephrol Dial Transplant. 1999; 14 (Suppl 1): 73–75.

  18. Drueke T.B. Foreword: Extraskeletal calcification in patients with chronic renal failure. Nephrol. Dial. Transplant. 2002; 17: 330–331.

  19. Ortiz-Capisano M.C., Ortiz P.A., Garvin J.L. Expression and functional calcium-sensing receptor in juxtaglomerular cells. Hypertension. 2007; 50(4): 737–743.

  20. Bricker N.S. On the pathogenesis of the uremic state. An exposition of the «Trade-off hypothesis». N.Engl. J. Med. 1972; 286; 1093–1099.

  21. Block G.A., Hulbert-Shearon T.E., Levin N.W. et al. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998; 31: 607–617.

  22. Brown E.M. Mechanism underlying the regulation of the parathyroid hormone secretion in vivo and in vitro. Curr. Opinion. Nephrol. Hypertension. 1993; 2: 541–551.

  23. Kuhlman M. Phosphate elimination in vodalities of hemodialysis and peritoneal dialysis. Blood Purif. 2010; 29: 137–144.

  24. Gotch F.A., Panlilio F., Sergeyeva O. et al. A kinetic model of inorganic phosphorus mass balance in hemodialysis therapy. Blood Purif. 2003; 21: 51–57.

  25. Lindsay R.M., Al-Hejaili F., Nesrallah G. Calcium and phosphate balance with quotidian hemodialysis. Am J Kidney Dis. 2003; 42,1[Suppl 1]: S24–S29.

  26. Daugirdas J.T., Chertow G.M., Larive B. et al. Effect of frequent hemodialysis on measures of CKD mineral and bone disorder. J Am Soc Nephrol. 2012; 23: 727–738.

  27. Dusso A.S., Thadhani R., Slatopolsky E. Vitamin D receptor and analogs. Semin Nephrol. 2004; 24(1): 10–16.

  28. Martin K.J., Gonzalez E.A. Vitamin D analogs: actions and role in the treatment of secondary hyperparathyroidism. Semin Nephrol. 2004; 24(5): 456–459.

  29. Lindberg J., Martin K.J., Gonzales E.A. A long-term, multicenter study of the efficacy and safety of paricalcitol in the end-stage renal disease. Clin Nephrol. 56(4): 315–323.

  30. Llach F., Yudd M. Paricalcitol in dialysis patients with end-stage renal disease: A century-old phenomenon. Kidney Int. 2002 (82): 73–80.

  31. Sprague S.M. Llach F., Amdahl M. Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int. 2003; 63(4): 1483–1490.

  32. Teng M., Wolf M., Ofsthum M.N. Activated Injectable Vitamin D and Hemodialysis Survival: A Historical Cohort Study 10.1681/ASN.2004070573. J Am Soc Nephrol. 2005; 16(4): 1115–25.

  33. Wu-Wong J.R., Tian J., Nakane M. Cardiovascular disease in chronic kidney failure: the role VDR activators. Curr Opin Investig Drugs. 2006; 7(3): 2006–213.

  34. Шутов Е.В., Лашутин С.В., Люосев В.С. и др. Новые возможности в лечении вторичного гиперпаратиреоза при комбинированной терапии цинакальцетом и малыми дозами активного метаболита витамина D. Клиническая нефрология. 2011; 5; 41–46.

  35. Smajilovic S., Sheykhzade M., Holmegard H.M. Calcimimetic, AMG 073, induces relaxation on isolated rat aorta. Vascul Pharmacol. 2007; 47(4): 222–228.

  36. Janssen M.J.A., van der Kuy A., Ter Wee P.M., Van Boven W.L.P. Aluminum hydroxide, calcium carbonate and calcium acetate in chronic intermittent hemodialysis patients. Clin Nephrol.; 1996; 45: 111–119.

  37. Михайлова Н.А. Магнийсодержащие фосфатбиндеры: новые терапевтические возможности при хронической болезни почек. Клиническая нефрология. 2013; 4: 47–52.

  38. Смирнов А.В., Волков М.М., Добронравов В.А. и др. Фосфорно-кальциевый обмен и состояние сердечно-сосудистой системы у пациентов с ранними стадиями хронической болезни почек. Тер. Арх. 2010; 6: 25–28.

  39. Block G.A., Wheeler D.C., Persky M.S. et al. Effects of phosphate binders in moderate CKD. J Am Soc Nephrol. 2012; 23: 1407–1415.

  40. Chertow G.M., Raggi P., McCarthy J.T. et al. The effects of sevelamer and calcium acetate on proxies of atherosclerotic and arteriosclerotic vascular disease in hemodialysis patients. Am J Nephrol. 2003; 23: 307–314.

  41. Chertow G.M., Burke S.K., Raggi P. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002; 62: 245–252.

  42. Sadek T., Mazouz H., Bahloul H. et al. Sevelamer hydrochloride with or without alphacalcidol or higher dialysate calcium vs calcium carbonate in dialysis patients: an open-label, randomized study. Nephrol Dial Transplant. 2003; 18: 582–588.

  43. Braun J., Asmus H.G., Holzer H. et al. Long-term comparison of a calcium-free phosphate binder and calcium carbonate–phosphorus metabolism and cardiovascular calcification. Clin Nephrol. 2004; 62: 104–115.

  44. Block G.A., Spiegel D.M., Ehrlich J., et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int. 2005; 68: 1815–1824.

  45. Block G.A., Raggi P., Bellasi A. et al. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int. 2007; 71: 438–441.

  46. Russo D., Miranda I., Ruocco C. et al. The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer. Kidney Int. 2007; 72: 1255–1261.

  47. Borzecki A.M., Lee A., Wang S.W. et al. Survival in end stage renal disease: calcium carbonate vs sevelamer. J Clin Pharm Ther. 2007; 32: 617–624.

  48. Barreto D.V., Barreto Fd.C., de Carvalho A.B. et al. Phosphate binder impact on bone remodeling and coronary calcification—results from the BRiC study. Nephron. 2008; 110: 273–283.

  49. Qunibi W., Moustafa M., Muenz L.R. et al. A 1-year randomized trial of calcium acetate versus sevelamer on progression of coronary artery calcifi cation in hemodialysis patients with comparable lipid control: the Calcium Acetate Renagel Evaluation-2 (CARE-2) study. Am J Kidney Dis. 2008; 51: 952–965.

  50. Suki W.N., for the Dialysis Clinical Outcomes Revisited Investigators. Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients: results of a randomized clinical trial. J Ren Nutr. 2008; 18: 91–98.

  51. Takei T., Otsubo S., Uchida K. et al. Effects of sevelamer on the progression of vascular calcification in patients on chronic haemodialysis. Nephron. 2008; 108: 278–283.

  52. Wilson R., Zhang P., Smyth M. et al. Assessment of survival in a 2-year comparative study of lanthanum carbonate versus standard therapy. Curr Med Res Opin. 2009; 25: 3021–3028.

  53. Panichi V., Bigazzi R., Paoletti S. et al. Impact of calcium, phosphate, PTH abnormalities and management on mortality in hemodialysis: results from the RISCAVID study. J Nephrol. 2010; 23: 556–562.

  54. Shantouf R., Ahmadi N., Flores F. et al. Impact of phosphate binder type on coronary artery calcifi cation in hemodialysis patients. Clin Nephrol. 2010; 74: 12–18.

  55. Jean G., Lataillade D., Genet L. et al. Calcium carbonate, but not sevelamer, is associated with better outcomes in hemodialysis patients: results from the French ARNOS study. Hemodial Int. 2011; 15: 485–492.

  56. Kakuta T., Tanaka R., Hyodo T. et al. Effect of sevelamer and calcium-based phosphate binders on coronary artery calcifi cation and accumulation of circulating advanced glycation end products in hemodialysis patients. Am J Kidney Dis. 2011; 57: 422–431.

  57. Toussaint N.D., Lau K.K., Polkinghorne K.R. et al. Attenuation of aortic calcification with lanthanum carbonate versus calcium-based phosphate binders in haemodialysis: a pilot randomized controlled trial. Nephrology (Carlton). 2011; 16: 290–298.

  58. Di Iorio B., Bellasi A., Russo D. Mortality in kidney disease patients treated with phosphate binders: a randomized study. Clin J Am Soc Nephrol. 2012; 7: 487–493.

  59. Navaneethan S.D. et al. Benefits and harms of phosphate binders in CKD: a systematic review of randomized controlled trials. Am J Kidney Dis. 2009; 54: 619–637.

  60. Jamal S.A., Fitchett D., Lok C.E. et al. The effects of calcium-based versus non-calcium-based phosphate binders on mortality among patients with chronic kidney disease: a meta-analysis. Nephrol Dial Transplant. 2009; 24: 3168–3174.

  61. Jamal S.A., Vandermeer B., Ragg P. et al. Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Published Online July 19, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)60897-1.

  62. Moher D., Liberati A., Tetzlaff J. et al for the PRISMA group. Preferred reporting items for systematic reviews and meta-analyses; the PRISMA statement. Ann Intern Med. 2009; 151: 264–269.

  63. Di Iorio B., Nargi O., Cucciniello E. et al. Coronary artery calcification progression is associated with arterial stiffness and cardiac repolarization deterioration in hemodialysis patients. Kidney Blood Press Res. 2011; 34: 180–187.

  64. Higgins J.P.T., Green S. Cochrane handbook for systematic reviews of interventions, version 5.0.2. Chichester, West Sussex: The Cochrane Collaboration and John Wiley & Sons, 2008.

  65. DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986; 7: 177–188.

  66. Di Iorio B., Molony D., Bell C. et al. Sevelamer versus calcium carbonate in incident hemodialysis patients: results of an open-label 24-month randomized clinical trial. Am J Kidney Dis. 2013 Oct; 62(4): 771–778.

  67. Земченков А.Ю. Герасимчук Р.П., Вишневский К.А. и др. Гиперфосфатемия у пациентов с хронической болезнью почек на диализе: риски и возможности коррекции. Клиническая нефрология. 2013; 4; 13–20.


Об авторах / Для корреспонденции


Хорошилов С.Е. – заведующий отделением гемодиализа ФГКУ «Главный военный клинический госпиталь им. акад. Н.Н. Бурденко» Минобороны России, д.м.н.


Похожие статьи


Бионика Медиа