维持中心血液透析(ICHD)患者的磷平衡是有问题的,尽管建议饮食限制,透析和磷酸盐粘合剂使用。处方药物中P含量很少被考虑,但这个来源应该引起关注。数据来自费森尤斯肾脏护理(FKC)电子数据仓库知识中心和MedReview-eRx访问的Surescripts,其中包含80%的美国处方。对MedReview-eRx数据库中处方≥1种药物的成年FKC ICHD患者(695,759张处方)进行分析。收集的信息包括药物剂量、剂量单位、剂量时机、剂量、开始和结束日期、再填充、人口统计信息、入院历史和方式类型。然后分析患者数量、个体用药处方和药物类别。报告使用>的药物100次。计算每种药物的中位数剂量/天(片剂数量)(随机选择的一天开放订单)。在FKC诊所使用常规药理学文献评估药物的磷酸盐含量,并计算潜在的磷酸盐和药丸负担。FKC透析患者处方药物排名前5位的是钙通道阻滞剂(22%)、质子泵抑制剂(PPIs; 18%), acetaminophen-opioid (AO; 13%), angiotensin-converting enzyme inhibitors (ACEi; 10%), and α2-agonists (9%). The maximum phosphate added for different medications varied by manufacturer. For instance, at median daily doses, phosphate contributions from the top five medications prescribed were 112 mg for amlodipine, 116.2 mg from lisinopril, 6.7 mg from clonidine, 0 mg from acetaminophen, and 200 mg for omeprazole. Prescribing these together could increase the daily phosphate load by 428 mg, forcing the patient to exceed the recommended daily intake (RDI) with food and drink. Phosphate content in medications prescribed to HD patients can substantially contribute to the daily phosphate load and, in combination, may even exceed the daily recommended dietary phosphate intake. Healthcare providers should monitor all medications containing phosphate prescribed in order to minimize risk of uncontrolled hyperphosphatemia and poor adherence.
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