Abstract: Objectives To evaluate the efficacy of active charcoal combined with rhubarb containing preparation in refractory hyperphosphatemia in patients on dialysis. Methods This was a multi-center, prospective and cross-over study. Patients on hemodialysis or peritoneal dialysis with stable disease condition but with hyperphosphatemia (serum phosphate > 1.78mmol/L) that could not be successfully controlled by conventional methods were selected. Patients were randomly assigned into 2 groups. Patients in therapy group received Aixite 1.5g with meal three times per day, and Shenshuaining, a composite preparation containing rhubarb, 4 pills three times per day. Dose of Shenshuaining was increased or decreased depending on patients’ gastrointestinal symptoms. Patients’ diet habit and other therapies remained unchanged. After 1 month, patients in treatment group were changed to control group, and those in control group to treatment group. Patients were then followed up for another 1 month. Changes of serum phosphate, albumin and hemoglobin between treatment group and control group were compared using paired t test. Results Fifty patients from 6 dialysis facilities were selected, of whom 24 patients were males, and 15 patients were on peritoneal dialysis. The average age and vintage were 56±13 and 4.9±3.1 years, respectively. Three patients were not included in the final analysis: one lost our follow-up, one had diarrhea before the treatment, and one took food unstably. The treatment decreased serum phosphate by about 0.35±0.67mmol/L (P=0.0010, compared with that of control group). Serum phosphate level lowered to <1.78mmol/L in 36.2% patients. Serum calcium and iPTH levels did not alter during the treatment period. Diarrhea happened in 3 patients and constipation in 3 patients, and the symptoms released after adjustment of Shenshuaining dose. Conclusions Active charcoal combined with rhubarb containing preparation is effective as an adjuvant measure in control of hyperphosphatemia in patients on dialysis, and provides a new approach for the treatment of hyperphosphatemia. Because the short observation period and small sample size, further study is needed to find out the long term benefits and risks of this regimen.

Key words: Peritoneal dialysis, Hyperphosphotemia, Active charcoal, Rhubarb containing preparation