Efficacy of Colestimide as a phosphate binder in patients on chronic hemodialysis Toshiyuki Date, Yoshiteru Kawashita, Nobuyoshi Satake Jin-ai-kai Dat

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1 Efficacy of Colestimide as a phosphate binder in patients on chronic hemodialysis Toshiyuki Date, Yoshiteru Kawashita, Nobuyoshi Satake Jin-ai-kai Date Clinic In some patients on chronic hemodialysis, serum phosphorus (P) levels were decreased during administratio of Colestimide, a hypercholesterolemia drug that absorbs bile acid. This study investigated the effectiveness of Colestimide as a phosphate binder. Serum P levels were determined before and after treatment with Colestimide for 4 weeks in 31 prospective patients and the results were as follows: 1) There was no difference in serum P levels at 4, 2, and 0 weeks before treatment, but those levels decreased significantly with Colestimide treatment from 6.1 }1.1mg/dl to 5.5 }1.2, 5.4 }1.1 and 5.3 }1.2mg/dl at 2, 3 and 4 weeks after treatment (p< repeated measure ANOVA). Decrease in the mean serum level was significant after 2 weeks (Dunnett multiple comparison). 2) The total serum calcium (Ca) concentration showed no significant difference at 4, 2 and 0 weeks before treatment. The total serum Ca concentration decreased significantly at 1, 2, 3, and 4 weeks after Colestimide treatment (p= repeated measure ANOVA). The total serum Ca concentration decreased from 9.8 }0.6 mg/dl to 9.5 }0.8mg/dl and 9.5 }0.7mg/dl at 3 and 4 weeks after Colestimide treatment, respectively and the decrease was significant after 3 weeks (Dunnett multiple comparison). Blood Ca ion levels, however, were

2 changed from 2.61 }0.15mEq/l to 2.58 }0.16mEq/l, showing little difference. Serum levels of total protein and albumin also showed little change after Colestimide treatment; therefore, it was suggested that the lowered total Ca level might be specifically attributed to complex Ca. This study showed that Colestimide treatment could control serum P level without causing hypercalcemia and that it may be feasible to co-administer active vitamin D medication. Based on this study, Colestimide was highly recommended for use as a non-absorbable phosphate binder.

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7 E: Poly [allylamine Hydrochloride] (RenaGel) non-calcemic phosphate binder for the treatment of hyperphosphatemia in chronic renal failure. Am J Kidney Dis 29: 66-71, ) Katz A, Hampers CL, Merrill JP: Secondary hyper parathyroidism and renal osteodystrophy in chronic renal failure. Medicine 48: , ) Rodoriguez M, Martin-Malo A, Martinez MD, Torres A, Felsenfeld AJ, Llac F: Calcemic response to parathyroid hormone in renal failure: Role of phosphorus and its effect on calcitriol. Kidney Int 40: , ) Slatopolsky EA, Burke SK, Dillon MA, and The RenaGel_??_ Study Group: RenaGel_??_, a nonabsor bed calcium-and alminium-free phosphate binder, lowers serum phosphorus and paraphyroid hormone. Kidney Int 55: , ) Chertow GM, Dillon M, Burke SK, Steg M, Bleyer AJ, Garrett BN, Domoto DT, Wilkes BM, Wombolt DG, Slatopolsky E: A randomized trial of seve lamer hydrochloride (RenaGel) with and without supplemental calcium. Clin Nephrol 51: 18-26, ) Schneider J, Egbring R, Kretschmer V, Kaffarnik H: Acquired coagulation defect in resin-treated hypercholesterolaemia. Lancet II 8517: , ) Goldberg DI, Dillon MA, Slatopolsky EA, Garrett B, Gray JR, Marbury T, Weinberg M, Wombolt D, Burke SK: Effect of RenaGel_??_, a non-absorbed, calcium-and alminium-free phosphate binder, on serum phosphorus, calcium, and intact parathyroid hormone in end-stage renal disease patients. Ne phrol Dial Transplant 13: , ) Chertow GM, Burke SK, Lazarus M, Senzel KH, Wombolt D, Goldberg D, onventre JV, Slatopolsky 19) Panichi V, Andreini B, De Pietro S, Migliri M, Taccola D, Giovannini L, Ferdenghini M, Palla R: Calcitriol oral therapy for the prevention of secon dary hyperparathyroidism in patients with predialytic renal failure. Clin Nephrol 49: , 1998

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表 K/DOQI ガイドラインに示された骨ミネラル代謝マーカーの管理目標値 CKD P mg/dl Ca mg/dl 7.CKD に伴う骨ミネラル代謝異常 ipth pg/ml KDOQI 表 b 7 CKD に伴う骨ミネラル代謝異常 ステートメント 1 CKD に伴う骨ミネラル代謝異常 (mineral and bone disorder:mbd) (CKD-MBD) の疾患概念 CKD 患者における骨ミネラル代謝異常は, 腎性骨異栄養症に加えて血管の合併症を含む, 生 命予後に影響する全身性疾患 (CKD-MBD) として捉える a). 2 CKD-MBD における Ca と P の管理目標

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