长期使用低钙透析液对腹膜透析患者钙磷代谢的影响

Long-term dialysis with low-calcium solution in CAPD: effects on calcium phosphate metabolism

目的 观察规律性腹透患者使用低钙腹透液的有效性和安全性。方法 在规律性 随访的患者中选择高血钙和(或)高血磷,iPTH<150 pg／ml的患者25例,改用Baxter PD4透析液 (钙1．25 mmol／L,其余成分不变),同时增加碳酸钙用量。使用低钙透析液期间每1～2个月检测 血总钙、血磷、iPTH和血白蛋白,同时观察患者使用低钙透析液有何不适。结果 在使用标准钙 透析液的1年中,血钙浓度逐渐升高,血iPTH逐渐下降,并差异有统计学意义。换用低钙透析液 治疗后,第1个月的血钙值明显下降(P<0．05),且维持在正常范围。腹透治疗开始时每日碳酸 钙(2．83±0．53)g,低钙透析液治疗后每日碳酸钙为(3．57±0．74)g(P<0．05)。治疗后2个月和3 个月,血磷浓度较治疗前略有下降,差异有统计学意义。iPTH值同样在第1个月时显著升高(P <0．05),以后未观察到再进行性升高,并维持在200 pg／ml左右。血清白蛋白在治疗前后差异无 统计学意义。在整个治疗过程中,1例患者治疗2周后出现低钙,iPTH升高明显而停用低钙透析 液。其余患者能很好地耐受低钙透析,没有低血压、抽搐等情况发生。结论 在高钙、高磷、低转 运骨病的腹膜透析患者中使用钙浓度为1．25 mmol／L的透析液透析同时注意钙的补充,有助于 钙磷代谢和骨病的改善。

Objective To investigate the effectiveness and safeness of low calcium dialysate in CAPD patients. Methods Twenty-five CAPD patients with hyperealcium and/or hyperphosphate and iPTH〈150 pg/ml were selected in this study. Standard calcium dialysate solution （1.75 mmo/L） was changed to lower calcium dialysate （Baxter PD4 with calcium concentration 1.25 mmol/L）. Calcium carbonate was used at the meantime. Serum calcium, phosphate and iPTH were detected periodically and any uncomfortable events were recorded. Results Serum calcium was gradually increased while iPTH was significantly decreased following 1 year of standard calcium dialysate. After changing to PD4, serum calcium concentration decreased, and iPTH increased significantly in the first month but maintained an acceptable level （200 pg/ml） afterwards. Meanwhile the dosage of calcium carbonate was changed from （2.83±0.53）g/d to （3.57±0.74） g/d. Serum phosphate was lower slightly with statistic significance in the second and the third month. Serum albumin was not different. Majority of patients toleranced low calcium dialysate well （no hypotension and no hyperspasmia）, only one stopped the treatment because of low serum calcium concentration and high iPTH. Conclusion Changing calcium concentration to 1.25 mmol/L is safety in hypercalcium and/or hyperphosphate with low bone turnover peritoneal dialysis patients. It can improve the calcium and phosphate metabolism with adequacy calcium intake.