肾功能不全和低磷:在长期拉米夫定联合阿德福韦酯治疗

StephenW

Source: J Gastroenterol  |  Posted 3 days ago
Renal dysfunction and hypophosphatemia during long-term lamivudine plus adefovir dipivoxil therapy in patients with chronic hepatitis B; Tanaka M, Suzuki F, Seko Y, Hara T, Kawamura Y, Sezaki H, Hosaka T, Akuta N, Kobayashi M, Suzuki Y, Saitoh S, Arase Y, Ikeda K, Kobayashi M, Kumada H; Journal of Gastroenterology (Mar 2013)

   

BACKGROUND: Renal dysfunction and Fanconi's syndrome associated with hypophosphatemia caused by long-term administration of low-dose adefovir dipivoxil (ADV) has been reported in recent years. The aim of this retrospective study was to determine the incidence and factors associated with renal dysfunction and hypophosphatemia in patients with hepatitis B infection on long-term treatment with ADV and lamivudine (LAM). METHODS: The study subjects were 292 patients treated with 10 mg/day ADV and 100 mg/day LAM for more than 6 months. We evaluated estimated glomerular filtration rate (eGFR), serum creatinine and serum phosphate level at the start of ADV and every 6 months. RESULT: During a median treatment duration of 64 months, 28 (9.6 %) patients developed renal impairment (defined as eGFR < 50 ml/min/1.73 m(2)), and 73 (27.1 %) developed hypophosphatemia, including 14 with persistent hypophosphatemia. The cumulative incidences of renal impairment at 1, 3, and 5 years were 1.4, 7.5, 10.5 %, respectively, and those of hypophosphatemia were 6.8, 20.6, 26.7 %, respectively. Multivariate analysis identified old age, liver cirrhosis and hypertension as determinants of renal impairment, and male sex, HCC, low baseline serum phosphate as determinants of hypophosphatemia. Three of the 14 patients with persistent hypophosphatemia developed Fanconi's syndrome; their serum creatinine level remained normal, but eGFR was lower than at baseline. CONCLUSION: Long-term treatment of hepatitis B with low-dose (10 mg/day) ADV and LAM can potentially cause renal impairment and hypophosphatemia. We advocate regular monitoring of serum phosphate and evaluation of eGFR, in addition to serum creatinine, in such patients.

StephenW

。背景：肾功能不全者和与由低-剂量的的阿德福韦酯的（ADV）的长期-长期的行政管理的引起的低血磷症相关联的范康尼的综合征已经被报道在最近几年。的此追溯性的研究中的目的是，以确定的发病率和与在与B型肝炎感染上的与ADV和拉米夫定（LAM）的长期-长期的的治疗的患者中的肾功能功能障碍和低磷血症相关联的的因素。方法：这项研究的科目分别为与10毫克/天ADV和100毫克/天LAM为更多的超过6个月内治疗的的292例患者。诚意评估了估计的肾小球滤过率（eGFR），血清肌酐和上面的开始的ADV和每6个月的的血清磷酸盐电平。 RESULT：二十八日（在一个64个月的的治疗的持续时间中位数期间中，）（9.6％）例患者开发的肾功能减值测试（定义见作为，eGFR的<50 mL/min/1.73 m2的（2）条），，和73（27.1％）发达的低血磷症，其中包括14与持久性低血磷症。在1，3，年和5年肾功能减值的累计发生率的分别为1.4，7.5，10.5％，分别，，并那些成低磷酸盐血症分别为6.8，20.6，26.7％，分别为。多变量分析确定的老年龄，肝功能肝硬化和高血压作为肾功能减值的的决定因素，和男性性爱的，HCC，低基线血清磷酸盐作为成低磷酸盐血症的的决定因素。三的14个与持续性低血磷症的患者开发的范可尼氏综合征;他们的的血清肌酐水平仍保持正常的，，但eGFR的是比在基线时较低的。结论：B型肝炎与低-剂量的（10毫克/天）ADV和LAM可以潜在地引起肾功能的发生减值和低磷血症的-长期的治疗。诚意主张的血清磷酸盐且表皮生长因子受体的计算值。的定期监测的，在除了到血清肌酐外，在这样患者

咬牙硬挺

出现这种问题如何是好呢

MP4

咬牙硬挺 发表于 2013-5-8 16:25
出现这种问题如何是好呢

减低AD密度或换药