不同钙离子浓度透析液对血液透析患者钙平衡及甲状旁腺素的影响

Effects of different calcium concentration dialysate on calcium balance and iPTH during hemodialysis

目的研究不同钙离子浓度透析液对维持性血液透析(MHD)患者透析过程中钙平衡及全段甲状旁腺激素(iPTH)的影响,为透析患者个体化选择透析液钙离子浓度提供理论依据。方法12例血钙正常的稳定的MHD患者分别使用钙离子浓度为1.25mmol/L(DCa1.25)、1.5mmol/L(DCa1.5)和1.75mmol/L(DCa1.75)的透析液进行血液透析(透析液其他成分不变),每次透析4h。检测透析前后血清总钙(tCa)、离子钙(iCa)、iPTH及透析废液的iCa和磷(P),并对血压进行监测。结果使用DCa1.25时,患者体内丢失的钙平均为5.03mmol,但透后血iCa和tCa浓度与透前相比无明显变化,iPTH透后较透前显著升高(P<0.05)。使用DCa1.5时,患者体内钙的蓄积平均为1.4mmol,透后血iCa和tCa浓度与透前相比明显升高(P<0.01),其中25%的患者发生透后高血钙,iPTH较透前无明显变化;使用DCa1.75时,患者体内钙的蓄积平均为3.3mmol,透后血iCa和tCa浓度比透前明显升高(P<0.01),其中83.3%的患者发生透后高血钙,iPTH较透前明显降低(P<0.01)。3种透析液对血磷的清除无明显差异(P>0.05)。结论对于透前血钙水平正常的患者,DCa1.75的透析液明显增加了患者的钙负荷,增加了透后高钙血症的发生。DCa1.25的透析液能够明显减轻钙负荷,但长期使用应注意监测iPTH水平。对于透前轻度低血钙或在?

Objective To evaluate the acute effects of different calcium concentration dialysate (1.25 mmol/L, 1.5 mmol/L, 1.75 mmol/L) on calcium balance and intact parathyroid hormone(iPTH) in maintenance hemodialysis(MHD) patients with normal serum tCa, and to provide scientific basis for individualized calcium concentration dialysate formula. Methods Dialysate with different calcium concentration (DCa1.25, DCa1.5, DCa1.75) was used in twelve stable MHD patients. Serum tCa, iCa(normalized to pH 7.4) and iPTH were assessed before and after each dialysis session with different calcium concentration dialysate. The iCa from fresh dialysate, spent dialysate at every 30 minutes interval and final total mixed spent dialysate were examined respectively. Phosphorus removal was also determined. Arterial blood pressure(BP) was measured every 30 minutes during hemodialysis session. Results With the DCa1.25, mean calcium loss was 5.03 mmol, but no significant changes of serum iCa and tCa between pre dialysis and post dialysis were found. Serum iPTH increased from (127.17±89.22)pg/ml to (281.92±244.84)pg/ml significantly (P< 0.05). With the DCa1.5, mean body calcium accumulation was 1.4 mmol, serum iCa and tCa increased significantly (P< 0.01) and iPTH did not change significantly as comparaed to pre dialysis. With the DCa1.75, mean body calcium accumulation was 3.3 mmol, serum iCa and tCa increased significantly (P< 0.01) and iPTH decreased significantly from (167.17±113.88)pg/ml to (80±82.28)pg/ml as comparaed with pre dialysis values(P< 0.01). There was no obvious difference in mean phosphorus removal among DCa1.25, DCa1.5 and DCa1.75. Conclusions Calcium influx from the dialysate to the patients occurred in the MHD patients with normal serum tCa when they were dialyzed with DCa1.75.Such influx leads to hypercalcemia. DCa1.25 may result in calcium efflux from the patients to the dialysate, which is suitable for patients with hypercalcemia or serum tCa in high normal range. DCa1.5 can be used in patients with slight hypocalcemia or serum tCa in low normal range, but if hypercalcemia occurs, it should be replaced by DCa1.25.