复方-α酮酸联合高通量血液透析器对血液透析患者残余肾功能和钙磷代谢的影响

Effect of compound-αketoacid combined with high-flux hemodialyzer on residual renal function and calcium and phosphorus metabolism in hemodialysis patients

目的探讨复方-α酮酸联合高通量血液透析器对血液透析患者残余肾功能(residual renal function,RRF)和钙磷代谢的影响。方法选取2014年12月至2019年12月海军安庆医院收治的184例血液透析患者,采用随机数表法将其分为A组、B组、C组和D组,每组46例。A组以低通量血液透析器进行常规血液透析(HD)治疗,B组采用复方-α酮酸联合HD治疗,C组采用单纯高通量血液透析(HFHD)治疗,D组采用复方α-酮酸联合HFHD治疗,均持续治疗6个月。对比4组透析龄、透析频率等基线资料;对比治疗前后4组RRF水平、钙磷代谢指标;对比治疗期间4组不良反应发生率。结果4组透析龄、透析频率、尿素氮、血肌酐水平及既往服用非含钙的磷结合剂构成比比较,差异均无统计学意义(P>0.05)。治疗前4组RRF水平比较,差异无统计学意义(P>0.05)。治疗后D组(1.21±0.14)RRF水平高于其余3组(A组:0.35±0.05;B组:0.82±0.07;C组:0.37±0.04)(P<0.05),且B组RRF水平高于A组和C组(P<0.05);与治疗前比,4组RRF水平均降低(P<0.05);治疗前4组血钙、血磷水平、钙磷乘积、甲状旁腺激素(iPTH)水平比较,差异均无统计学意义(P>0.05),治疗后D组血磷水平、钙磷乘积、iPTH水平均低于其余3组(P<0.05),且B组低于A组和C组(P<0.05),4组血钙水平差异无统计学意义(P>0.05);与治疗前比,4组血磷水平、钙磷乘积、iPTH水平均降低(P<0.05),4组血钙水平均无变化(P>0.05);治疗期间4组恶心/呕吐、便秘等不良反应发生率及总发生率比较,差异均无统计学意义(P>0.05)。结论复方-α酮酸联合高通量血液透析器可保护血液透析患者残余肾功能,降低血磷水平,调节钙磷代谢,安全可靠。

Objective To investigate the effects of compound-αketoacid combined with high-flux hemodialyzer on residual renal function(RRF)and calcium and phosphorus metabolism in hemodialysis patients.Methods One hundred and forty-eight hemodialysis patients admitted to the hospital from December 2014 to December 2019 were randomly divided into Group A,Group B,Group C and Group D,each consisting of 46 patients.Group A received routine hemodialysis(RH)with a low flux dialyzer,Group B was treated with compound-αcombined with ketoacid plus RH,Group C was treated simply with high-flux hemodialysis(HFHD),and Group D was treated with compoundα-ketoacid plus HFHD.All the patients had a continuous treatment course of 6 months.The year and frequency of dialysis and other basic medical data were compared between the 4 groups.The levels of RRF and the indexes of calcium and phosphorus metabolism were compared before and after treatment.Comparisons of the rate of adverse reactions during treatment were also made between the 4 groups.Results No statistical significance could be noted in the composition ratio of dialysis year and frequency,urea nitrogen,serum creatinine and non-calcium-containing phosphorus binders,when comparisons were made between the 4 groups(P>0.05).Statistical significance could neither be seen in differences in RRF levels between the 4 groups,as compared with those before treatment(P>0.05).After treatment,the RRF level in Group D was higher than those in the other 3 groups(P<0.05),and the RRF level in Group B was higher than those in Group A and Group C(P<0.05).Compared with those before treatment,RRF levels in the 4 groups decreased(P<0.05).There were also no significant differences in the levels of serum calcium,phosphorus,calcium-phosphorus product and iPTH level,when comparisons were made with those before treatment between the 4 groups(P>0.05).After treatment,the levels of blood phosphorus,calcium-phosphorus product and iPTH level in Group D were all lower than those in the other 3 groups(P<0.05),those in Group B were lower than those in Group A and Group C(P<0.05).However,no differences could be found in the levels of blood calcium,when comparisons were made between the 4 groups(P>0.05).Compared with those before treatment,the levels of serum phosphorus and calcium-phosphorus product and the levels of iPTH in the 4 groups decreased(P<0.05).However,no obvious changes in blood calcium could be noticed,when comparisons were made between the 4 groups(P>0.05).During the course of treatment,the rate of nausea/vomiting,constipation and other adverse reactions and the total rate of adverse reactions could neither be found in the 4 groups,when comparisons were made between the 4 groups(P>0.05).Conclusion Compound-αketoacid combined with high-flux hemodialyzer could protect the residual renal function,reduce blood phosphorus level and regulate calcium and phosphorus metabolism of hemodialysis patients,and was safe and reliable.