不同剂量含钙磷结合剂纠正腹膜透析患者钙磷代谢紊乱有效性和安全性评价

Efficacy and safety evaluation of different doses of calcium-containing phosphate binders to correct calcium and phosphorus metabolism disorder in peritoneal dialysis patients

目的:评估接受腹膜透析治疗并伴有肾性骨病的慢性肾脏疾病(chronic kidney disease,CKD)患者使用不同剂量含钙磷结合剂(calcium-containing phosphate binders,CCPB)纠正钙磷代谢紊乱的有效性和安全性。方法:回顾性地收集2013年1月1日至2019年12月31日就诊于天津市第一中心医院的CKD-5D期接受腹膜透析伴有肾性骨病的成人患者,根据使用CCPB的剂量分为低钙组(元素钙≤1 500 mg·d^(-1),58例)和高钙组(元素钙>1 500 mg·d^(-1),54例),分析随访2年内患者的血钙、血磷、全段甲状旁腺激素(iPTH)等实验室数据达标情况以及心血管事件发生率和再入院率。结果:高钙组患者血钙达标率低于低钙组,且因心脑血管事件入院的发生率明显高于低钙组(35.2%vs 17.2%,P=0.030),但新发骨质疏松的比例显著低于低钙组(25.9%vs 5.6%,P=0.003)。合并使用活性维生素D(VitD)对患者实验室数据的达标率和CCPB常见不良反应的发生率无明显影响,但全程合并使用活性VitD可以减少患者出现继发性甲状旁腺功能亢进(SHPT)。结论:相比于高钙组,低剂量能更稳定地使腹膜透析伴有肾性骨病的CKD患者血钙达标,在没有发生SHPT的情况下,不建议合用活性VitD制剂。

OBJECTIVE To assess the efficacy and safety of different doses of calcium-containing phosphate binders(CCPB)for correcting calcium and phosphorus metabolism disorders in patients with chronic kidney disease(CKD)undergoing peritoneal dialysis and renal osteodystrophy.METHODS Adult patients with CKD-5D undergoing peritoneal dialysis and renal osteodystrophy treated at a Tianjin First Central Hospital from January 1,2013 to December 31,2019 were retrospectively collected and divided into low-calcium group(element calcium≤1500 mg∙d^(-1),n=58)and high-calcium group(element calcium>1500 mg∙d^(-1),n=54).The qualified rates of serum calcium,serum phosphorus,intact parathyroid hormone(iPTH)and other laboratory data,as well as the incidence of cardiovascular events and hospital admission in the patients during 2-year follow-up were analyzed.RESULTS The high-calcium group had a lower rate of the qualified rate of serum calcium than the low-calcium group,and had a significantly higher rate of hospital admission for cardiovascular and cerebrovascular events than the low-calcium group(35.2%vs 17.2%,P=0.030),but the rate of new osteoporosis was significantly lower than that in the low calcium group(25.9%vs 5.6%,P=0.003).The combined use of active VitD had no significant effect on the qualified rate of laboratory data and the incidence of common adverse reactions of CCPB,but the combined use of active VitD throughout the course could reduce the occurrence of secondary hyperparathyroidism(SHPT)in patients.CONCIUSION Compared with the high-calcium group,the low-calcium group can more stably reach the blood calcium standard in CKD patients with renal osteodystrophy on peritoneal dialysis.In the absence of SHPT,the combination of active VitD preparations is not recommended.