Современные возможности применения фосфат-связывающих препаратов у больных, находящихся на диализе


Е.А. Горелова, Н.Н. Чернышева, О.Н. Котенко, Е.В. Шутов

1 ГБУЗ «Городская клиническая больница им. С.П. Боткина», Москва 2 ГБУЗ «Городская клиническая больница № 52 ДЗМ», Москва 3 ГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» МЗ РФ, Москва
Гиперфосфатемия у больных хронической болезнью почек (ХБП) на диализе ассоциируется с высоким риском развития сердечно-сосудистых осложнений и летальностью. Контроль над сывороточным фосфором уже давно признан одной из ключевых целей в лечении пациентов с ХБП. Основными стратегиями в профилактике и лечении гиперфосфатемии являются гипофосфатная диета, адекватный диализ и применение фосфат-связывающих препаратов (ФСП).
В статье представлен обзор, посвященный использованию наиболее распространенных ФСП. В нем обсуждаются фармакокинетика, побочные эффекты, дозировка (начальные и средние дозы), фосфат-связывающая способность (ФСС) и противопоказания к назначению ФСП. Представлены новые подходы в контроле уровня над сывороточным фосфором у пациентов с ХБП, получающих диализ.
Изложены принципы назначения ФСП с учетом их эффективности и переносимости, фосфатной нагрузки, наличия сопутствующих заболеваний и противопоказаний к применению. Представлены алгоритм и результаты сравнительной оценки фосфат-связывающей способности (ФСС) ФСП на основании использования относительного коэффициента связывания фосфатов (ОКСФ) и эквивалентной фосфат-связывающей дозы (ЭФСД), облегчающие выбор дозы ФСП. Высокая фосфат-связывающая способность препаратов улучшает эффективность коррекции гиперфосфатемии, позволяет уменьшить лекарственную нагрузку и повысить приверженность пациентов назначенной терапии.

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Об авторах / Для корреспонденции


Информация об авторах:
Горелова Е.А. – врач-нефролог ГБУЗ «ГКБ им. С.П. Боткина», Москва.
E-mail: gorelova.ea@mail.ru
Чернышева Н.Н. – врач-нефролог ГБУЗ «ГКБ им. С.П. Боткина», Москва
Котенко О.Н. – к.м.н., главный специалист по нефрологии ДЗМ, заместитель главного врача по нефрологической помощи ГБУЗ ГКБ № 52 ДЗМ.
Email: info@gkb52.mosgorzdrav.ru.
Шутов Е.В. – д.м.н., профессор кафедры нефрологии и гемодиализа ГБОУ ДПО РМАНПОМЗ РФ, заведующий отделением диализа ГБУЗ «ГКБ им. С.П. Боткина», Москва


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