维持性血液透析患者应用不同钙浓度透析液的钙平衡

Calcium mass balance in maintenance hemodialysis patients treated with dialysates containing different calcium concentrations

目的对比不同钙浓度透析液透析过程中钙转运的量及48h钙平衡。方法随机抽取20例维持性血液透析患者,分别给予钙浓度为1.50mmol/L和1.75mmol/L的透析液进行常规血液透析各1周,计算透析过程中钙转运量(calcium mass transfer,CMT),记录患者48h饮食及服用碳酸钙和骨化三醇的情况,估算食物钙含量、钙剂含钙量、维生素D3摄入量,计算消化道钙吸收量(CaAbs)。结合CMT与CaAbs计算钙平衡(calcium mass balance,CMB)。分别对CMT、CMB与其他参数进行相关性分析。结果测算得两种透析液治疗CMT差异无显著性,tCMT分别为137.51±343.2(mg)和297.15±438.78(mg),(t=-1.18,P=0.256);CaAbs差异无显著性,145.6±92.1(mg)对146.3±92.7(mg),(t=-0.89,P=0.388);CMB48h差异无显著性,268.2±364.9(mg)对443.4±438.1(mg),(t=-1.29,P=0.215)。其中tCMT的相关因素为透析废液量(B=-1.50,t=-12.13)和新-废透析液总钙浓度差ΔtCaF-S(B=120.24,t=63.37),CMB48h的相关因素则只有tCMT(B=39.51,t=24.70),P均<0.001。结论使用1.50mmol/L和1.75mmol/L钙透析液透析均使钙向MHD患者体内转运,二者转运量相当;透析过程中钙转运是MHD患者钙平衡的关键因素,透析钙转运量受超滤除水量和透析液钙浓度影响。

Objective To compare the difference of calcium mass balance in maintenance hemodialysis patients treated with dialysates containing different calcium concentrations. Methods We randomly selected 20 maintenance hemodialysis patients in a single hemodialysis center into this study. They were treated with the standard hemodialysis protocol using the dialysate containing 1.50mmol/L and 1.75mmol/L calcium, respectively, each for one week. The calcium mass transfer （CMT） in every hemodialysis session was calculated. The intake of calcium from diet and calcium bicarbonate and the dose of calcitriol in the 48 h period were recorded, from which calcium absorption from intestine （CaAbs） was calculated. Calcium mass balance in the 48 h period （CMB48h） was derived from CMT and CaAbs. The correlation among CMT, CMB48h and other parameters were analyzed. Results There were no significant differences in total CMT （tCMT, 3.44=t=8.58mmol vs. 7.43±10.97mmol; t = -0.93, P=-0.256）, CaAbs （145.6±92. lmg vs. 146.3=t=92.7mg; t = -0.89, P=0.388）, and CMB48h （268.2±364.9mg vs. 443.4＋438.1mg; t = -1.29, P=0.215） between the dialysis period using the dialysate of 1.50mmol/L calcium and that using the dialysate of 1.75mmoFL calcium. Dialysate output volume （B = -1.50, t = -12.13, P 〈 0.001） and AtCaF-S （B =120.24, t = 63.37, P 〈 0.001） were the correlation factors for tCMT, and tCMT was the only correlation factor for CMB48h （B = 39.51, t = 24.70, P 〈 0.001）. Conclusions Calcium mass transfers from dialysate to blood with similar tCMT during the hemodialysis using dialysate containing 1.50mmol/L or 1.75mmol/L calcium, tCMT during hemo-dialysis is an important factor for CMB48h in maintenance hemodialysis patients, and is affected by ultrafiltration volume and calcium concentration in dialysate.