低钙透析联合碳酸钙对血透患者高磷血症的治疗效果

Effect of low calcium dialysate unite carbolic calcium on hemodialysis patients with hyperphosphatemia

目的观察应用低钙透析联合口服碳酸钙对血液透析患者高磷血症的治疗及对血钙、钙磷乘积、甲状旁腺激素水平、血压的影响。方法 31例伴有高磷血症、血钙正常的维持性血液透析(MHD)患者,先后采用钙浓度(DCa)为1.50mmol/L、1.25mmol/L透析液透析各6个月。应用DCa1.25mmol/L透析时31例患者透析间期口服碳酸钙片0.3g,每日3次。使用两种透析液透析均在透析初始、3个月、6个月时(观察终点)检测透析前血钙、血磷、血清全段甲状旁腺素(iPTH)、观察透析前后血压及不良反应。结果观察终点与初始值比较,应用DCa1.50mmol/L6个月,血钙、钙磷乘积和全段甲状旁腺素(iPTH)均上升(P<0.05);应用DCa1.25mmol/L6个月,血钙水平有所下降,血磷与钙磷乘积显著下降(P<0.05),iPTH水平有所上升(P<0.05)。观察低钙透析不良反应的发生率为4/31(12.9%),主要为肌痉挛、低血压、甲状旁腺激素水平升高。结论对合并高磷血症的MHD患者,阶段性采用低钙透析液联合口服碳酸钙的方法,可以有效地降低血磷、降低钙磷乘积,值得临床推广使用。

Objective To observe the effect of low calcium dialysate unite carbolic calcium on hemodialysis patients with hyperphosphatemia. And the influences of serum calcium, calcium - phosphorus product, intact parathyroid hormone （ iPTH）, blood pressure. Methods 31 cases on maintenance hemondialysis were observed, these patients firstly received high calcium dialysate （1.5 mmol/L）for 6 months, then accepted low calcium dialysate（ 1.25 mmol/L） therapy for 6 months. While hemodialysis with low calcium dialysate（ 1.25 mmol/L） carbolic calci- um was applied every day. Serum calcium, phosphate, parathyroid hormone and blood pressurewere measured before and after one dialysis session at 3 and 6 months later. Results During 6 months with high calcium dialysate, serum calcium, phosphate and parathyroid hormone increased （P 〈 0. 05） ;But during 6 months with low calcium dialysate, serum calcium dicreased, serum phosphate and calcium - phosphate product decreased remarkedly （P 〈 0. 05 ）. Parathyroid hormone increased （P 〈 0. 05 ）. The rates of adverse reaction is 4/31 （ 12. 9% ）, include muscle spasm, hypotension, the level of iPTH increased . Conclusion The treatment with 1.25 mmol/L calcium dialysate unite carbolic calcium effectively decreased serum phosphatemia and Calcium - phosphorous product. The method is suitable for maintenance hemondialysis patients with hyperphosphatemia and deserved to use in clinic.