[Management of hyperphosphoremia].
Phosphorus is involved in the pathogenesis of hyperparathyroidism in Chronic Renal Failure (CRF) and in extra-osseous calcifications. Therefore, it is directly related with the morbi-mortality of these patients. The control of phosphorus is of the utmost importance and is often extremely difficult to achieve. A quick overview of the drugs that can bind phosphorus is given in this paper. Iron salts are beginning to come through as a viable possibility in the near future; nevertheless, calcium salts continue to be the most widespread. The problem is the ease with which a positive calcium balance can be produced, as extra-osseous calcifications (and above all, vascular calcifications) can appear and morbid-mortality increases. As a result of all this, calcium-free binders such as lanthanum carbonate and sevelamer are eagerly awaited. The lanthanum is as of yet little and not very well known. Sevelamer possesses good phosphorus-binding properties, as it is insoluble, does not cause intestinal degradation, does not contain traces of other elements and its use has few side effects. Long-term studies and accumulated experience have demonstrated its efficacy as a binder, plus additional advantages such as an improvement in the lipid profile, with a decrease in LDL--and an increase in HDL-cholesterol. As to whether these new binders--or any other compounds that could appear-will be of any real use only time will tell.
Amor
J
J
Servicio de Nefrología, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani, s/n 41071 Sevilla.
Palma
A
A
D002114:Calcinosis / Q000139:chemically induced / Q000517:prevention & control; D002118:Calcium / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D019090:Case Management; D002614:Chelating Agents / Q000627:therapeutic use*; D015913:Chelation Therapy; D004852:Epoxy Compounds / Q000627:therapeutic use; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000209:etiology; D007501:Iron / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications; D007811:Lanthanum / Q000627:therapeutic use; D010758:Phosphorus / Q000097:blood*; D011073:Polyamines; D011095:Polyethylenes / Q000627:therapeutic use; D000069603:Sevelamer
D002614:Chelating Agents; D004852:Epoxy Compounds; D011073:Polyamines; D011095:Polyethylenes; D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer; D007501:Iron; D002118:Calcium