Korean Journal of Nephrology 1990;9(4):470-476.

만성 신부전 환자에서 Sucralfate의 혈청 인 저하 효과

김구엽 , 안재형 , 이태원 , 임천규 , 김명재

Abstract

Renal osteodystrophy associated with a secondary hyperparathyroidism is induced by hypocalcemia in chronic renal failure. The low serum calcium levels are caused in part by hyperphosphatemia. Aluminum hydroxide is used to correct hyperphosphatemia by binding phosphate in the bowel and reducing the absorp- tion of phosphate. However, aluminum intoxication can induce anemia, osteomalacia, and dementia. For these reasons, it is desirable to reduce the exposure to alumi- num. We evaluated the effect of sucralfate (aluminum salt of sucrose octasulfate) on the level of serum phos- phorous, calcium, aluminum, and parathyroid hormone (mid-molecule) at 1 week interval during 3 weeks admin- istration. The result were as follows; 1) Serum phosphorous concentration was decreased from 7.99±0.41 mg/dl to 3.49±0.23 mg/dl after 4 weeks of sucralfate treatment and from 6.75±0.46 mg/dl to 3. 58±0.31 mg/dl after 4 weeks of aluminum hydroxide treatment (p<0.001). The change of serum phosphorous level per gram of aluminum intake was higher in sucralfate group compared with that in aluminum hydroxide group (6.72 mg/dl/g vs 2.35 mg/dl/g). 2} Serum calcium concentration was increased from 6.95±0.32mg/dl to 8.34±0.22mg/dl after 4weeks of sucralfate treatment and from 7.57±0.17 mg/dl to 8.52± 0.17 mg/dl after 4 weeks of aluminum hydroxide treatment(p < 0, 001). The change of the serum calcium level per gram of aluminum intake was higher in sucralfate group compared with that in aluminum hydroxide group (2.07 mg/dl/g vs. 0.71 mg/dl/g). 3) Serum aluminum level was increased from 24.92± 3.34 pg/l to 101.69±11.35 pg/1 after 4 weeks of sucral- fate treatment and from 23.62±3.48 pg/I to 126.31±11. 24 pg/1 after 4 weeks of aluminum hydroxide treatment (p < 0. 001). The change of the serum aluminum level per gram of aluminum intake was higher in sucralfate group compared with that in aluminum hydroxide group (114. 58 pg/l/g vs.75.92mg/l/g). 4) Serum PTH level was decreased from 601.77±109. 29pmol/l to 544.53±120.71pmol/l after 4 weeks of sucralfate treatment (p>0.1). Serum PTH level was decreased from 576.50±69.82 pmol/l to 473.97±105.36 pmol/l after 4 weeks of aluminum hydroxide treatment (p>0.1). In conclusion, sucralfate seems to be superior to aluminum hydroxide for the treatment of hyperphos- phatemia but associated with high level of serum alumi- num in patients with chronic renal failure.