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


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Аннотация

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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Е. А Горелова

ГБУЗ «Городская клиническая больница им. С.П. Боткина»

Email: gorelova.ea@mail.ru
врач-нефролог Москва

Н. Н Чернышева

ГБУЗ «Городская клиническая больница им. С.П. Боткина»

врач-нефролог Москва

О. Н Котенко

ГБУЗ «Городская клиническая больница № 52 ДЗМ»

Email: info@gkb52.mosgorzdrav.ru
к.м.н., главный специалист по нефрологии ДЗМ, заместитель главного врача по нефрологической помощи Москва

Е. В Шутов

ГБУЗ «Городская клиническая больница им. С.П. Боткина»; ГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» М3 РФ

д.м.н., профессор кафедры нефрологии и гемодиализа; заведующий отделением диализа Москва

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