长期使用Ca^+1.25mmol/L透析液对维持性血液透析患者矿物质代谢的影响

The long-term effect of 1.25 mmol/l calcium in dialysate on mineral metabolism in maintenance hemodialysis patients

目的观察长期应用钙离子浓度为1.25mmol/L的低钙透析液(low calcium dialysate,LCa D)对维持性血液透析患者(maintained hemodialysis,MHD)矿物质代谢的影响。方法选择进行血液透析治疗3个月以上的慢性肾衰竭患者50例,分别观察应用低钙透析液3,6,9个月后钙磷,甲状旁腺激素的变化。结果应用1.25mmol/L的低钙透析液透析后不同血钙水平的组别及不同i PTH水平的组别血钙浓度均有明显下降。整体观察血磷在低钙透析3,6个月时无明显改变,9个月时有明显下降(P<0.05)。血i PTH多在低钙透析3个月时无明显改变,应用至6,9个月后有明显升高(P<0.05)。结论低钙透析可降低部分血液透析患者血钙水平,使得血磷更易控制;但同时可能加重SHPT,需同时合理使用钙剂及活性维生素D。

Objective To observe the long-term effect of 1.25 mmol/1 calcium in dialysate （LCaD） on mineral metabolism in maintenance hemodialysis （MHD） patients. Methods A total of 50 chronic renal fail- ure patients with MHD for more than 3 months were randomly recruited from our hospital. The effects of LCaD on serum calcium, phosphorus, and intact parathyroid hormone （iPTH） were observed after the treat- ment for 3, 6, 9 months. Results After the use of LCaD, we found that serum calcium level dramatically de- clined in the patients with different serum calcium levels and different serum iPTH levels （P〈0.05）. Serum phosphorus was unchanged after the treatment of LCaD for 3 and 6 months, but decreased after the treatment for 9 months （P〈0.05）. Serum iPTH was unchanged after the treatment for 3 months, and increased signifi- cantly after the treatment for 6 and 9 months （P〈0.05）. Conclusion Low calcium in dialysate can decrease the serum calcium level in some of MHD patients, and can effectively control the serum phosphorus. Howev- er, low calcium in dialysate will increase the risk of secondary hyperparathyroidism. Therefore, calcium and active vitamin D preparations should be supplemented at the same time.