不同钙浓度透析液在血液透析滤过中对钙磷代谢、甲状旁腺激素与醛固酮的影响

Influence of calcium concentration in dialysate on calcium,phosphate,intact parathyroid hormone and aldosterone during hemodiafiltration

目的研究不同钙浓度透析液对血液透析滤过(HDF)中钙磷代谢、甲状旁腺素(iPTH)及醛固酮(ALD)的影响。方法60例慢性肾衰竭(CRF)伴难治性高血压患者分别用三种钙浓度透析液行HDF,测定HDF前后血清离子钙(iCa)、磷(P)、iPTH、ALD及血压水平。结果钙浓度1.25mmol/L(DCa1.25)组:iCa、P、ALD及血压均明显降低,iPTH无明显变化;钙浓度1.5mmol/L(DCa1.5)组:iCa无明显变化,P、ALD及iPTH降低;钙浓度1.75mmol/L(DCa1.75)组:iCa升高,P、iPTH及ALD降低。结论HDF中低钙透析不仅减轻高钙负荷和转移性钙化,同时不升高iPTH水平并明显降低ALD水平,可有效改善患者高血压。

Objective To evaluate the effect of calcium concentration in dialysate on serum ionized Ca （iCa）, phosphate （P）, intact parathyroid hormone （iPTH） and aldosterone （ALD） during hemodiafiltration （HDF） in chronic renal failure patients. Methods Sixty patients were assigned into 3 groups based on the calcium concentration in dialysate. Serum iCa, P, iPTH, ALD and blood pressure were measured before and after HDF session. Results In the group using Ca^＋2 1.25mmol/l in dialysate, iCa, P, ALD and blood pressure decreased significantly, and iPTH remained unchanged. In the group using Ca^＋2 1.5mmol/l in dialysate, iCa unchanged but P, iPTH and ALD decreased. In the group using Ca^＋2 1.75mmol/l in dialysate, iCa increased significantly but P, iPTH and ALD decreased. Conclusion Treatment with the addition of low calcium dialysate to hemodiafiltration is beneficial to reduce calcium load and serum ALD, to prevent iPTH from increase, and to decrease blood pressure.