Questions from kidney friends:
Authoritative answers to questions
Q:
"Calcium carbonate and calcium acetate are cheaper, so why would the doctor give me the expensive Sveram?"
Sveram is a calcium-free binder. The kidney friend may be in a state of hypercalcemia, so calcium carbonate and calcium acetate are not suitable because of their calcium content.
Q: "My blood phosphorus 2.03mmol/l Sveram has not come down, but has risen to 2.76mmol/l!" Will changing to lanthanum carbonate work?"
For this kidney friend, the cause of the drug itself cannot be considered only. It may be stubborn hyperphosphatemia caused by medication taking, eating habits, etc. Although the effect of lanthanum carbonate in reducing phosphorus is better than that of Sveram, it is very one-sided to ignore other factors and not find its own causes. Didn't you let the phosphorus-lowering medicine carry a big cauldron!
Q: "I don't prescribe medicine at the doctor's place!" I want to buy Sveram or sucralfate myself, can I? ”
It is possible to buy sveram yourself, as long as it is produced by a regular manufacturer, within the shelf life range, and taken under the guidance of a doctor. However, since sucralfate is an aluminum-containing binder, long-term application can cause metal ion deposition, triggering and aggravating cardiovascular adverse reactions. Recommended as directed by a healthcare practitioner.
Q: "I only have 1.21 mmol/l of blood phosphorus now, can I stop taking phosphorus-lowering drugs?"
Vary. First of all, we need to know the source of phosphorus, the food in our daily life, as small as a grain of rice, a bun. In addition to boiled water, the vast majority of foods contain phosphorus to some extent. And what is the main reason for the removal of phosphorus from our body? kidney! 30% of the phosphorus can be excreted in the daily stool, and the remaining 70% of the phosphorus is almost entirely excreted by the kidneys, and a small part can be excreted through sweat. When the kidneys are dysfunctional, eat more and drain less! Blood phosphorus naturally rises! Therefore, it is necessary to add a reasonable diet plus phosphorus binders to control blood phosphorus at normal levels. For kidney friends with end-stage renal disease (uremia): it is generally necessary to use a phosphorus-lowering trilogy, regular dialysis + dietary control + rational use of phosphorus binders.
Q: "I have low calcium, can I eat calcium carbonate?"
OK.
Q: "How much phosphorus can I eat per day?"
Limit daily intake of phosphorus to less than 800 mg.
Q: "Which is more useful for phosphorus removal, hemodialysis or peritoneal dialysis?"
Hemodialysis dialysis 3 times a week, each dialysis time of 4 h, about 2.3 to 2.6 g of phosphorus per week. For patients on peritoneal dialysis, 2 L of dialysate is exchanged 4 times a day, and about 2.0 to 2.2 g of phosphorus can be removed per week.
I believe that everyone has read this and has a certain understanding of the relevant knowledge of phosphorus. Below, we briefly talk about a phosphorus reduction drug.
Calcium-containing phosphorus binders: calcium carbonate, calcium acetate
Applicable population: low calcium and high phosphorus population
Precautions: High calcium is not suitable, excessive use of calcium-containing phosphorus binders is harmful for non-dialysis patients
Directions: Chew with meals
Studies suggest that calcium carbonate is insoluble in water, needs to consume a lot of stomach acid, and patients with atrophic gastritis with gastric acid deficiency should not be used. Animal experiments have found that calcium acetate, as a calcium supplement, may promote the absorption of aluminum and lead, which is not conducive to the excretion of aluminum and lead from the body, and has a negative effect on maintaining the health of bones and nervous system. Relatively speaking, calcium carbonate may be safer as a calcium supplement.
Aluminum phosphorus binding agent: sucralfate, aluminum hydroxide
Suitable for: people with high phosphorus
Precautions: Long-term use is easy to cause osteomalacia and encephalopathy
Studies suggest that long-term application can cause metal ion deposition, trigger and aggravate cardiovascular adverse reactions, and damage nerve cells.
Phosphorus binder without calcium and aluminum: carbonic acid (hydrochloric acid) sveram
Precautions: Gastrointestinal reactions may worsen metabolic acidosis
Dosage: Take whole capsule with a meal
Studies suggest that siviram carbonate can not only effectively reduce the level of blood phosphorus, inhibit secondary hyperparathyroidism, but also do not increase blood calcium levels, can reduce complications of vascular and soft tissue calcification, sveram carbonate can also reduce the inflammatory response and blood uric acid in patients, correct renal osteodystrophy, but also reduce total cholesterol, low-density lipoprotein, effectively maintain bicarbonate levels, thereby reducing the mortality rate of patients with end-stage renal disease has a positive effect.
Phosphorus binder without calcium and aluminum: Lanthanum carbonate
Precautions: Gastrointestinal symptoms
Studies suggest that it can reduce the level of blood phosphorus and blood calcium, and has a high safety of medication, and can also avoid left ventricular hypertrophy and coronary artery calcification in patients, and does not cause full-segment parathyroid hormone iPTH accumulation.
Iron-containing phosphorus binders: iron citrate, iron sucrose hydroxide...
Applicable population: high phosphorus combined with iron deficiency anemia
Precautions: Gastrointestinal symptoms, including diarrhea, constipation, stool color, bloating
Take orally with meals
The International Journal of Urology and Nephrology has suggested that iron-based phosphate binders including hydrated iron citrate (FCH) and hydroxyl iron oxide (SFOH) continue to reduce serum phosphate concentrations, which are safe for long-term use in patients on maintenance hemodialysis, and iron citrate and iron sucrose hydroxide have been shown to be comparable to the effectiveness of reducing blood phosphorus compared with Sveram in patients with stage CKD3-5. May correct metabolic acidosis.
Tip: Ferric citrate (FC) is a new type of iron-containing phosphate binder, unlike traditional phosphorus binders, FC promotes iron absorption and increases hemoglobin levels while reducing serum phosphate levels. In 2014, the U.S. Food and Drug Administration approved iron citrate as a hypophosphate for patients on CKD dialysis.
Please note: everyone should choose the most suitable phosphorus lowering drug according to their symptoms and economic situation under the guidance of a doctor, and try not to buy it yourself!