Effect of intensive dietary education combined with lanthanum carbonate on hyperphosphatemia in patients with maintenance hemodialysis

doi:10.3877/cma.j.issn.2095-3216.2021.01.006

Abstract

Abstract:

Objective

To observe the effect of intensive dietary education combined with lanthanum carbonate on hyperphosphatemia in patients with maintenance hemodialysis.

Methods

At the Air Force Special Medical Center from January 2018 to June 2020, a total of 60 patients, who had blood phosphorus ≥2.0 mmol/L, regular outpatient maintenance hemodialysis for more than 6 months, and treatment with oral lanthanum carbonate, were selected and divided into intensive diet education group and ordinary diet education group, with 30 cases in each group. The levels of the patients′ blood phosphorus (P), corrected blood calcium (Ca), calcium-phosphorus product (Ca×P), intact parathyroid hormone (iPTH), hemoglobin (Hb), albumin (Alb), and KT/V were observed after 1 month.

Results

Compared with the ordinary diet education group, the intensive diet education group had a significant decrease in blood phosphorus, and the calcium and phosphorus product (P<0.01). The total effective rate of blood phosphorus reduction in the intensive diet education group (70%) was significantly higher than that in the ordinary diet education group (33.3%) (P<0.01). There was no significant difference in blood Ca, Hb, Alb, and KT/V between the two groups before and after the treatment.

Conclusion

Intensive dietary education combined with lanthanum carbonate significantly improved the hyperphosphatemia of patients with maintenance hemodialysis.

Key words: Intensive dietary education, Maintenance hemodialysis, Hyperphosphatemia, Lanthanum carbonate

Jing Shan, Dong Liu, Zhuo Gao, Ruihai Hu, Xinlun Li, Ding Chen. Effect of intensive dietary education combined with lanthanum carbonate on hyperphosphatemia in patients with maintenance hemodialysis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2021, 10(01): 31-34.

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References 17

[1]	林丽萍，李佳梦，苏白海. 减轻CKD患者磷肠道负荷的重要环节——药物含磷及低磷/蛋白质比值饮食[J]. 中国血液净化，2018, 17(6): 412-415.
[2]	Yu X, Fang Y, Liu H, et al. The balance of beneficial and deleterious effects of hypoxia-inducible factor activation by prolyl hydroxylase inhibitor in rat remnant kidney depends on the timing of administration [J]. Nephrol Dial Transplant, 2012, 27(8): 3110-3119.
[3]	Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis，evaluation，prevention，and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) [J]. Kidney Int Suppl, 2009, 113: S1-S130.
[4]	Jiang N, Fang W, Gu AP, et al. Improving diet recipe and cooking methods attenuates hyperphosphatemia in patients undergoing peritoneal dialysis [J]. Nutr Metab Cardiovasc Dis, 2015, 25(9): 846-852.
[5]	孙岩，兰超，张菁菁，等. 醋酸钙片治疗腹膜透析患者高磷血症的疗效观察[J]. 中国中西医结合肾病杂志，2013, 14(9): 784-786.
[6]	Danese MD, Belozeroff V, Smimakis K, et al. Consistentcontrol of mineral and bone disorder in incident hemodialysis patients [J]. Clin J Am Soc Nephrol, 2008, 3(5): 1423-1428.
[7]	Palmer SC, Hayen A, Macaskill P, et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis [J]. JAMA, 2011, 305(11): 1119-1127.
[8]	Bellasi A, Cozzolino M, Adragao T, et al.Phosphate binders in moderate chronic kidney disease：where do we stand ？[J]. J Nephrol, 2013, 26(6): 993-1000.
[9]	张晓娟，郭华，唐少文，等. 碳酸镧与传统磷结合剂治疗维持性血液透析患者高磷血症的Meta分析[J]. 中华肾脏病杂志，2013, 29(5): 339-346.
[10]	贾凤玉，刘志红. 慢性肾脏病患者应用磷结合剂的新认识[J]. 肾脏病与透析肾移植杂志，2014, 23(2): 171-175.
[11]	李英．慢性肾脏病高磷血症的治疗[J]. 临床荟萃，2016, 31(6): 590-593.
[12]	Watanabe MT, Araujo RM, Vogt BP, et al. Most consumed processed foods by patients on hemodialysis: alert for phosphate-containing additives and the phosphate-to-protein ratio [J]. Clin Nutr ESPEN, 2016, 14: 37-41.
[13]	王梅. 慢性肾脏病患者高磷血症的治疗[J]. 肾脏病与透析肾移植杂志，2014, 23(3): 247-248.
[14]	Goto S, Komaba H, Moriwakiet K, et al. Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in Japan [J]. Clin J Am Soc Nephrol, 2011, 6(6): 1375-1384.
[15]	Toussaint ND, Lau KK, Polkinghome KR, et al. Attenuation of aortic calcification with lanthanum carbonate versus calcium-based phosphate binders in haemodialysis: a pilot randomized controlled trial [J]. Nephrology (Carlton), 2011, 16(3): 290-298.
[16]	Shigematsu T, Tokumoto A, Nakaoka A, et al. Effect of lanthanum carbonate treatment on bone in Japanese dialysis patients with hyperphosphatemia [J]. Ther Apher Dial, 2011, 15(2): 176-184.
[17]	Ketteler M, Block GA, Evenepoel P, et al. Diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder: synopsis of the Kidney Disease: Improving Global Outcomes 2017 clinical practice guideline update [J]. Ann Intern Med, 2018, 168(6): 422-430.

组别	例数	性别[例(%)]		年龄(岁)	透析龄(M)	钙剂剂量(g)	体质量指数(kg/m²)	碳酸镧(g)
组别	例数	男	女	年龄(岁)	透析龄(M)	钙剂剂量(g)	体质量指数(kg/m²)	碳酸镧(g)
强化教育组	30	17(56.7)	13(43.3)	54.27±12.37	68.46±35.06	0.47±0.11	26.2±2.54	2.03±0.38
普通教育组	30	12(40.0)	18(60.0)	52.00±12.55	58.73±24.21	0.45±0.21	24.5±4.16	2.15±0.26
t/χ²值		0.258		0.704	1.251	0.434	0.762	0.682
P值		0.797		0.484	0.216	0.667	0.437	0.697

组别	例数	性别[例(%)]		年龄(岁)	透析龄(M)	钙剂剂量(g)	体质量指数(kg/m²)	碳酸镧(g)
组别	例数	男	女	年龄(岁)	透析龄(M)	钙剂剂量(g)	体质量指数(kg/m²)	碳酸镧(g)
强化教育组	30	17(56.7)	13(43.3)	54.27±12.37	68.46±35.06	0.47±0.11	26.2±2.54	2.03±0.38
普通教育组	30	12(40.0)	18(60.0)	52.00±12.55	58.73±24.21	0.45±0.21	24.5±4.16	2.15±0.26
t/χ²值		0.258		0.704	1.251	0.434	0.762	0.682
P值		0.797		0.484	0.216	0.667	0.437	0.697

组别	例数	实验室检查
组别	例数	Ca(mmol/L)	P(mmol/L)	Ca×P	iPTH(pg/ml)	Hb(g/L)	Alb(g/L)	KT/V
强化教育组治疗前	30	2.02±0.21	2.51±0.31	60.63±15.73	445.16±99.24	115.5±7.78	43.90±1.56	1.26±0.01
普通教育组治疗前	30	2.04±0.14	2.37±0.29	55.62±7.12	485.86±117.63	127.5±8.84	42.00±0.99	1.15±0.14
t值		-0.501	1.871	1.591	-0.719	-0.591	0.606	0.013
P值		0.618	0.068	0.119	0.475	0.557	0.546	0.989
组别	例数	实验室检查
组别	例数	Ca(mmol/L)	P(mmol/L)	Ca×P	iPTH(pg/ml)	Hb(g/L)	Alb(g/L)	KT/V
强化教育组治疗后	30	2.13±0.22	1.71±0.29^ab	43.52±9.43^ab	213.40±371.9^b	117.5±3.54	42.85±0.92	1.24±0.01
普通教育组治疗后	30	2.03±0.15	2.22±0.49	54.20±12.17	485.87±117.62	124.6±5.30	41.55±1.06	1.14±0.08
t/z值		1.103	-4.877	-3.827	-5.485	-0.752	0.177	-0.784
P值		0.274	<0.001	<0.001	<0.001	0.455	0.861	0.436

组别	例数	实验室检查
组别	例数	Ca(mmol/L)	P(mmol/L)	Ca×P	iPTH(pg/ml)	Hb(g/L)	Alb(g/L)	KT/V
强化教育组治疗前	30	2.02±0.21	2.51±0.31	60.63±15.73	445.16±99.24	115.5±7.78	43.90±1.56	1.26±0.01
普通教育组治疗前	30	2.04±0.14	2.37±0.29	55.62±7.12	485.86±117.63	127.5±8.84	42.00±0.99	1.15±0.14
t值		-0.501	1.871	1.591	-0.719	-0.591	0.606	0.013
P值		0.618	0.068	0.119	0.475	0.557	0.546	0.989
组别	例数	实验室检查
组别	例数	Ca(mmol/L)	P(mmol/L)	Ca×P	iPTH(pg/ml)	Hb(g/L)	Alb(g/L)	KT/V
强化教育组治疗后	30	2.13±0.22	1.71±0.29^ab	43.52±9.43^ab	213.40±371.9^b	117.5±3.54	42.85±0.92	1.24±0.01
普通教育组治疗后	30	2.03±0.15	2.22±0.49	54.20±12.17	485.87±117.62	124.6±5.30	41.55±1.06	1.14±0.08
t/z值		1.103	-4.877	-3.827	-5.485	-0.752	0.177	-0.784
P值		0.274	<0.001	<0.001	<0.001	0.455	0.861	0.436

组别	例数	无效	总有效
强化教育组	30	9(30.0)	21(70.0)
普通教育组	30	20(66.7)	10(33.3)
χ²值			4.537
P值			0.009

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