中文摘要：

尽管透析技术有了很大进展,而终末期肾病（end-stage renal disease,ESRD）患者血磷的控制仍面临很大挑战。为了控制血磷水平,不恰当的饮食控制可能会导致更高的病死率,因此合理应用磷结合剂非常必要。传统的磷结合剂由于其副作用逐渐被淘汰。作为非含钙非含铝磷结合剂的代表药物,司维拉姆能在降磷的同时降低血低密度脂蛋白（low tehsith lipoprotein,LDL）水平及高钙血症的风险。此外,司维拉姆对冠状动脉钙化积分（coronary artery calcification,CAC）的进展可能也有保护作用,可以降低慢性肾脏病（chronic kidney disease,CKD）患者心血管事件发生率。对65岁以上的血液透析患者,司维拉姆或许会显著降低全因病死率。磷结合剂的选用应确立个体化治疗方案,对于患有严重血管及其他软组织钙化、高钙血症、高脂血症的CKD患者,应优先选择司维拉姆来降低血磷水平。

英文摘要：

Despite great progress has been made in modalities of dialysis,phosphate control is still a major challenge in management of end-stage renal disease（ESRD） patients.Dietary phosphorus restriction may finally lead to increasing mortality;so it is necessary to rationally use phosphate binders.Traditional phosphate binders have being weeded out due to high incidence of adverse effects.Compared with calcium-containing phosphate binder,as the representative drug of non-calcium and non-aluminum-containing phosphate binders,sevelamer is effective in lowering serum phosphate and serum LDL,and is also beneficial for patients with hypercalcemia.In addition,sevelamer may prevent the progression of coronary artery calcification（CAC）,reducing the incidence of cardiovascular disease events in patients with chronic kidney disease（CKD）.Therefore,sevelamer may lower the all-cause mortality rate for dialysis patients aged 〉65 years.Phosphate binders should be used in an individualized way.Non-calcium phosphate binders is a prior choice for CKD patients with severe vascular and / or other soft-tissue calcifications and in those with hypercalcemia or hyperlipemia.