Коррекция гиперфосфатемии у пациента с терминальной стадией хронической болезни почек и сложным случаем анемии. Клинический случай

Фомин В.В. Коррекция гиперфосфатемии у пациента с терминальной стадией хронической болезни почек и сложным случаем анемии. Клинический случай. Consilium Medicum. 2024;26(1):62–66.
DOI: 10.26442/20751753.2024.1.202777

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Fomin VV. Correction of hyperphosphatemia in a patient with end-stage chronic kidney disease and a complex case of anemia. A clinical case. Consilium Medicum. 2024;26(1):62–66. DOI: 10.26442/20751753.2024.1.202777

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Аннотация

Препараты железа и/или переливание крови в сочетании с инъекциями рекомбинантного человеческого эритропоэтина регулярно используются для коррекции почечной анемии, которая является частым осложнением терминальной стадии заболевания почек. Однако массивные переливания крови и неадекватное внутривенное введение препаратов железа могут привести к синдрому перегрузки железом, а анемия не всегда носит нефрогенный характер. Представлен редкий клинический случай пациента с терминальной стадией хронической болезни почек со сложным генезом анемии, находящегося на гемодиализе. Случай интересен тем, что назначение препаратов 1-й линии носило угрожающий жизни характер, а для коррекции минерально-костных нарушений препаратом выбора стал севеламер.

Ключевые слова: хроническая болезнь почек, анемия, железо, севеламер, гемодиализ

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Iron supplements and/or blood transfusions in combination with recombinant human erythropoietin injections are routinely used to correct renal anemia, which is a common complication of end-stage renal disease. However, massive blood transfusions and inadequate intravenous iron supplementation can lead to iron overload syndrome, and anemia is not always nephrogenic. A rare clinical case of a patient with end-stage chronic kidney disease with complex genesis of anemia, who is on hemodialysis, is presented. The case is interesting because the prescription of first-line drugs was life-threatening in nature, and sevelamer was the drug chosen for the correction of mineral-bone disorders.

Keywords: chronic kidney disease, anemia, iron, sevelamer, hemodialysis

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Список литературы

1. Hamer RA, El Nahas AM. The burden of chronic kidney disease. BMJ. 2006;332(7541):563-4. DOI:10.1136/bmj.332.7541.563
2. Rodriguez M, Felsenfeld AJ. PTH, FGF-23 and early CKD. Nephrol Dial Transplant. 2008;23(11):3391-3. DOI:10.1093/ndt/gfn438
3. Qunibi WY. Cardiovascular calcification in nondialyzed patients with chronic kidney disease. Semin Dial. 2007;20(2):134-8. DOI:10.1111/j.1525-139X.2007.00260.x
4. Coen G, Pierantozzi A, Spizzichino D, et al. Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients. BMC Nephrol. 2010;11(10):1-9. DOI:10.1186/1471-2369-11-10
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6. Giachelli CM. Vascular calcification mechanisms. J Am Soc Nephrol. 2004;15(12):2959-64. DOI:10.1097/01.ASN.0000145894.57533.C4
7. Eschbach JW, Egrie JC, Downing MR, et al. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. Results of a combined phase I and II clinical trial. N Engl J Med. 1987;316(2):73-8. DOI:10.1056/NEJM198701083160203
8. Carter RA, Hawkins JB, Robinson BH. Iron metabolism in the anaemia of chronic renal failure. Effects of dialysis and of parenteral iron. Br Med J. 1969;3(5664):206-10. DOI:10.1136/bmj.3.5664.206
9. Milman N. Iron absorption measured by whole body counting and the relation to marrow iron stores in chronic uremia. Clin Nephrol. 1982;17(2):77-81.
10. Kalantar-Zadeh K, Rodriguez RA, Humphreys MH. Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrol Dial Transplant. 2004;19(1):141-9. DOI:10.1093/ndt/gfg493
11. Fishbane S, Pollack S, Feldman HI, Joffe MM. Iron indices in chronic kidney disease in the National Health and Nutritional Examination Survey 1988–2004. Clin J Am Soc Nephrol. 2009;4(1):57-61. DOI:10.2215/CJN.01670408
12. Kuragano T, Shimonaka Y, Kida A, et al. Determinants of hepcidin in patients on maintenance hemodialysis: role of inflammation. Am J Nephrol. 2010;31(6):534-40. DOI:10.1159/000312381
13. Young B, Zaritsky J. Hepcidin for clinicians. Clin J Am Soc Nephrol. 2009;4(8):1384-7. DOI:10.2215/CJN.02190309
14. Zaritsky J, Young B, Wang HJ, et al. Hepcidin – a potential novel biomarker for iron status in chronic kidney disease. Clin J Am Soc Nephrol. 2009;4(6):1051-6. DOI:10.2215/CJN.05931108
15. Волошина Н.Б., Осипенко М.Ф., Литвинова Н.В., Волошин А.Н. Гемохроматоз – современное состояние проблемы. Терапевтический архив. 2018;90(3):107-12 [Voloshinà NB, Osipenko MF, Litvinova NV, Voloshin A.N. Hemochromatosis – modern condition of the problem. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(3):107-12 (in Russian)]. DOI:10.26442/terarkh2018903107-112
16. Ganz T, Nemeth E. Iron Balance and the Role of Hepcidin in Chronic Kidney Disease. Semin Nephrol. 2016;36(2):87-93. DOI:10.1016/j.semnephrol.2016.02.001
17. KDOQI; National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis.
2006;47(5 Suppl. 3):S11-145. DOI:10.1053/j.ajkd.2006.03.010. Erratum in: Am J Kidney Dis. 2006;48(3):518.
18. Macginley R, Walker R, Irving M. KHA-CARI Guideline: use of iron in chronic kidney disease patients. Nephrology (Carlton). 2013;18(12):747-9. DOI:10.1111/nep.12139
19. Macdougall IC, Bircher AJ, Eckardt KU, et al; Conference Participants. Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference. Kidney Int. 2016;89(1):28-39. DOI:10.1016/j.kint.2015.10.002
20. Charytan C, Qunibi W, Bailie GR; Venofer Clinical Studies Group. Comparison of intravenous iron sucrose to oral iron in the treatment of anemic patients with chronic kidney disease not on dialysis. Nephron Clin Pract. 2005;100(3):c55-62. DOI:10.1159/000085049
21. KDIGO. KDIGO Clinical Practice Guideline for Anemia In Chronic Kidney Disease. Kidney Int Suppl. 2012;2(4):279-335.
22. Pitts TO, Barbour GL. Hemosiderosis secondary to chronic parenteral iron therapy in maintenance hemodialysis patients. Nephron. 1978;22(4-6):316-21. DOI:10.1159/000181469
23. Brown MC, Gaffney D, Gemmell C, et al. Hemochromatosis gene mutations and treatment of anemia in patients on hemodialysis. Hemodial Int. 2009;13(4):460-6. DOI:10.1111/j.1542-4758.2009.00378.x
24. Almasi M, Hajisalimi B. Comparing the effect of sevelamer carbonate versus sevelamer hydrochloride on blood level cholesterol, triglyceride and uric acid in patients undergoing maintenance hemodialysis. J Parathyr Dis. 2020;8:e11173.
25. Covic A, Ketteler M, Rastogi A, et al. Efficacy and Safety of Sucroferric Oxyhydroxide (Velphoro®; Pa21) and Sevelamer Carbonate in Haemodialysis Patients With or Without Diabetes: A Post Hoc Analysis of a Phase 3 Study. Conference: ERA-EDTA. 2014.
26. Nerild HH, Brønden A, Haddouchi AE, et al. Elucidating the glucose-lowering effect of the bile acid sequestrant sevelamer. Diabetes Obes Metab. 2024;26(4):1252-63. DOI:10.1111/dom.15421
27. Shakeri H, Panarelli NC. Patterns of gastrointestinal injury in patients with chronic kidney disease: Comparison of cases with and without sevelamer crystals. Histopathology. 2024;84(4):624-32. DOI:10.1111/his.15104

________________________________________________

1. Hamer RA, El Nahas AM. The burden of chronic kidney disease. BMJ. 2006;332(7541):563-4. DOI:10.1136/bmj.332.7541.563
2. Rodriguez M, Felsenfeld AJ. PTH, FGF-23 and early CKD. Nephrol Dial Transplant. 2008;23(11):3391-3. DOI:10.1093/ndt/gfn438
3. Qunibi WY. Cardiovascular calcification in nondialyzed patients with chronic kidney disease. Semin Dial. 2007;20(2):134-8. DOI:10.1111/j.1525-139X.2007.00260.x
4. Coen G, Pierantozzi A, Spizzichino D, et al. Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients. BMC Nephrol. 2010;11(10):1-9. DOI:10.1186/1471-2369-11-10
5. Volgina G, Seleznev D, Balkarova O, Lovchinsky E. Extraosseous calcification in patients with chronic kidney disease. Vrach. 2012;(7):2-8 (in Russian).
6. Giachelli CM. Vascular calcification mechanisms. J Am Soc Nephrol. 2004;15(12):2959-64. DOI:10.1097/01.ASN.0000145894.57533.C4
7. Eschbach JW, Egrie JC, Downing MR, et al. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. Results of a combined phase I and II clinical trial. N Engl J Med. 1987;316(2):73-8. DOI:10.1056/NEJM198701083160203
8. Carter RA, Hawkins JB, Robinson BH. Iron metabolism in the anaemia of chronic renal failure. Effects of dialysis and of parenteral iron. Br Med J. 1969;3(5664):206-10. DOI:10.1136/bmj.3.5664.206
9. Milman N. Iron absorption measured by whole body counting and the relation to marrow iron stores in chronic uremia. Clin Nephrol. 1982;17(2):77-81.
10. Kalantar-Zadeh K, Rodriguez RA, Humphreys MH. Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrol Dial Transplant. 2004;19(1):141-9. DOI:10.1093/ndt/gfg493
11. Fishbane S, Pollack S, Feldman HI, Joffe MM. Iron indices in chronic kidney disease in the National Health and Nutritional Examination Survey 1988–2004. Clin J Am Soc Nephrol. 2009;4(1):57-61. DOI:10.2215/CJN.01670408
12. Kuragano T, Shimonaka Y, Kida A, et al. Determinants of hepcidin in patients on maintenance hemodialysis: role of inflammation. Am J Nephrol. 2010;31(6):534-40. DOI:10.1159/000312381
13. Young B, Zaritsky J. Hepcidin for clinicians. Clin J Am Soc Nephrol. 2009;4(8):1384-7. DOI:10.2215/CJN.02190309
14. Zaritsky J, Young B, Wang HJ, et al. Hepcidin – a potential novel biomarker for iron status in chronic kidney disease. Clin J Am Soc Nephrol. 2009;4(6):1051-6. DOI:10.2215/CJN.05931108
15. Voloshinà NB, Osipenko MF, Litvinova NV, Voloshin A.N. Hemochromatosis – modern condition of the problem. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(3):107-12 (in Russian). DOI:10.26442/terarkh2018903107-112
16. Ganz T, Nemeth E. Iron Balance and the Role of Hepcidin in Chronic Kidney Disease. Semin Nephrol. 2016;36(2):87-93. DOI:10.1016/j.semnephrol.2016.02.001
17. KDOQI; National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis.
2006;47(5 Suppl. 3):S11-145. DOI:10.1053/j.ajkd.2006.03.010. Erratum in: Am J Kidney Dis. 2006;48(3):518.
18. Macginley R, Walker R, Irving M. KHA-CARI Guideline: use of iron in chronic kidney disease patients. Nephrology (Carlton). 2013;18(12):747-9. DOI:10.1111/nep.12139
19. Macdougall IC, Bircher AJ, Eckardt KU, et al; Conference Participants. Iron management in chronic kidney disease: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference. Kidney Int. 2016;89(1):28-39. DOI:10.1016/j.kint.2015.10.002
20. Charytan C, Qunibi W, Bailie GR; Venofer Clinical Studies Group. Comparison of intravenous iron sucrose to oral iron in the treatment of anemic patients with chronic kidney disease not on dialysis. Nephron Clin Pract. 2005;100(3):c55-62. DOI:10.1159/000085049
21. KDIGO. KDIGO Clinical Practice Guideline for Anemia In Chronic Kidney Disease. Kidney Int Suppl. 2012;2(4):279-335.
22. Pitts TO, Barbour GL. Hemosiderosis secondary to chronic parenteral iron therapy in maintenance hemodialysis patients. Nephron. 1978;22(4-6):316-21. DOI:10.1159/000181469
23. Brown MC, Gaffney D, Gemmell C, et al. Hemochromatosis gene mutations and treatment of anemia in patients on hemodialysis. Hemodial Int. 2009;13(4):460-6. DOI:10.1111/j.1542-4758.2009.00378.x
24. Almasi M, Hajisalimi B. Comparing the effect of sevelamer carbonate versus sevelamer hydrochloride on blood level cholesterol, triglyceride and uric acid in patients undergoing maintenance hemodialysis. J Parathyr Dis. 2020;8:e11173.
25. Covic A, Ketteler M, Rastogi A, et al. Efficacy and Safety of Sucroferric Oxyhydroxide (Velphoro®; Pa21) and Sevelamer Carbonate in Haemodialysis Patients With or Without Diabetes: A Post Hoc Analysis of a Phase 3 Study. Conference: ERA-EDTA. 2014.
26. Nerild HH, Brønden A, Haddouchi AE, et al. Elucidating the glucose-lowering effect of the bile acid sequestrant sevelamer. Diabetes Obes Metab. 2024;26(4):1252-63. DOI:10.1111/dom.15421
27. Shakeri H, Panarelli NC. Patterns of gastrointestinal injury in patients with chronic kidney disease: Comparison of cases with and without sevelamer crystals. Histopathology. 2024;84(4):624-32. DOI:10.1111/his.15104

Авторы

В.В. Фомин*

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*fomin_v_v_1@staff.sechenov.ru

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Victor V. Fomin*

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*fomin_v_v_1@staff.sechenov.ru

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