目的 探讨蔗糖羟基氧化铁治疗血磷控制不达标的血液透析患者高磷血症的临床有效性与安全性。 方法 回顾性分析2024年5月─2025年12月来自山西省4家三级甲等医院维持性血液透析(maintenance hemodialysis，MHD)患者，其均经规范磷结合剂治疗后仍存在高磷血症(血磷＞1.78 mmol/L)，遂换用蔗糖羟基氧化铁口服治疗12周。采取自身前后对照设计，分别观察治疗前和治疗后第2、4 、8、12周的血磷(serum phosphorus，P)水平，治疗前和治疗后第12周的铁代谢指标，并收集用药期间不良反应的发生情况。 结果 90例应用蔗糖羟基氧化铁的MHD患者，平均年龄(51.88±12.95)岁，透析龄(56.01±48.39)月，基础病因主要包括慢性肾炎综合征44例(48.89%)，糖尿病肾病20例(22.22%)。蔗糖羟基氧化铁治疗后第2周(Z=6.081，P＜0.001)、第4周(Z=10.465，P＜0.001)、第8周(Z=13.081，P＜0.001)、第12周(Z=12.327，P＜0.001)血磷水平较用药前均明显降低。用药第8周的血磷达标率达83.33%，第12周达85.56%。应用蔗糖羟基氧化铁治疗12周后血清铁蛋白水平较用药前出现升高(t=2.934，P=0.004)。所有患者均无严重不良事件的发生。 结论 蔗糖羟基氧化铁可有效降低血磷控制不达标的MHD患者的血磷水平，提升血清铁蛋白，改善铁储备状态，且整体安全性良好。

Objective To investigate the clinical efficacy and safety of sucroferric oxyhydroxide in the treatment of hyperphosphatemia in maintenance hemodialysis (MHD) patients with inadequately controlled serum phosphorus levels.  Methods  A retrospective analysis was performed on 90 MHD patients from four tertiary hospitals in Shanxi Province between May 2024 and December 2025. All patients had persistent hyperphosphatemia (serum phosphorus＞1.78 mmol/L) despite standard phosphate binder therapy and were switched to sucroferric oxyhydroxide for 12 weeks. A self-controlled, before-and-after design was employed to monitor serum phosphorus (P) levels at baseline and at 2, 4, 8 and 12 weeks after treatment initiation. Iron metabolism parameters were assessed at baseline and after 12 weeks of treatment, and adverse events occurring during treatment were recorded.  Results Among the 90 MHD patients treated with sucroferric oxyhydroxide, the mean age was (51.88±12.95) years, and the mean dialysis vintage was (56.01±48.39) months. The primary underlying diseases included chronic glomerulonephritis in 44 patients (48.89%) and diabetic nephropathy in 20 patients (22.22%). The median baseline serum phosphorus levels were 2.360 (2.118, 2.658) mmol/L. Serum phosphorus levels at all follow-up time points were significantly lower than the baseline level (Week 2: Z=6.081, adjusted P＜0.001; Week 4: Z=10.465, adjusted P＜0.001; Week 8: Z=13.081, adjusted P＜0.001; Week 12: Z=12.327, adjusted P＜0.001). The serum phosphorus target achievement rate reached 83.33% at Week 8 and 85.56% at Week 12. After 12 weeks of treatment, serum ferritin levels were significantly higher than at baseline (t=2.934, P=0.004). Although transferrin saturation (t=1.170, P=0.245) and serum iron (t=0.307, P=0.759) were slightly higher than baseline, the differences were not statistically significant. No serious adverse events occurred in any patient.  Conclusion  Sucroferric Oxyhydroxide effectively reduced serum phosphorus levels in MHD patients with inadequate phosphorus control, increased serum ferritin levels, and improved iron stores, with an overall favorable safety profile.