残余肾功能对血液透析患者钙磷代谢状况和死亡率的影响

The effect of residual renal function on calcium-phosphorus metabolism and mortality rate in hemodialysis patients

目的观察残余肾功能(RRF)对血液透析患者钙磷代谢状况和死亡率的影响。方法 86例血液透析患者按照残肾功能分为2组:透析间期24小时尿量大于200ml,存在RRF(A组);透析间期24小时尿量小于200 ml,RRF丧失(B组)。测定透析前后尿素氮、肌酐、透析间期尿量、透析前血钙磷乘积、血钙、血磷、甲状旁腺激素(PTH)水平。观察1年后两组患者的死亡率。结果 A组患者46例,平均24小时尿量(643±429)ml。血钙水平A组为(2.23±0.63)mmol/L,显著高于B组(1.86±0.49)mmol/L(P<0.05);血磷水平A组为(1.43±0.65)mmol/L,显著低于B组(2.36±1.18)mmol/L(P<0.05);血PTH水平A组为(350.2±123.5)pg/ml),显著低于B组(556.4±167.4)pg/ml(P<0.05)。1年后A组死亡率为11.2%,显著低于B组40.3%(P<0.05)。结论残余肾功能的维持能减轻钙磷代谢异常及继发性甲旁亢,残余肾功能能减少血液透析患者的死亡率。

Objective： To evaluate the effect of residual renal function（RRF） on calcium-phosphorus metabolism and mortality rate in hemodialysis patients.Methods： Eighty six hemodialysis patients were classified into two groups： with RRF（Group A）,urine volume200ml/ 24h;without RRF（Group B）,urine volume 200 ml/24 h.The impact of RRF on calcium-phosphorus metabolism and mortality rate was examined over a 1-year period.Results： The serum calcium was higher in patients with RRF than that without RRF.The serum phosphorus and PTH were lower in patients with RRF than those without RRF.During that period,the death rate was 11.2% in patients with RRF and 40.3% in patients without RRF（P0.05）.RRF was a significant independent predictor of mortality.Conclusion： RRF can slow down calcium-phosphorus metabolism and secondary hyperparathyroidism.The level of RRF is associated with mortality risk in hemodialysis patients.