Effects of Lanthanum Carbonate on Vascular Calcification in Elderly Maintenance Hemodialysis Patients

Summary： The effect of lanthanum carbonate on abdominal aortic calcification （AAC） in the elderly maintenance hemodialysis （MHD） patients was investigated. Fifty-four cases subjected to routine MHD complicated with skin pruritus admitted to our hospital were selected and randomly divided into case group （n=28） and control group （n=26）. The control group was given routine MHD alone. The case group was given lanthanum carbonate additionally on the basis of routine MHD. The changes of itching degrees at first and third month, and serum calcium, phosphorus, calcium-phosphorus products, intact parathyroid hormone （iPTH） levels and AAC scores at third month after treatments were compared be- tween the two groups. The correlation between calcium-phosphorus products and AAC scores was also analyzed. There was no significant difference in the baseline of blood urea nitrogen （BUN）, serum creatinine （Scr）, uric acid, albumin, hemoglobin, C reactive protein （CRP）, low density lipoprotein （LDL）, high density lipoprotein （HDL）, triglyceride, total cholesterol between case group and control group （P〉0.05 for all）. There was also no significant difference in the baseline itching scores between the case group and the control group （P〉0.05）. At 1st and 3rd month after treatment, the itching scores in the case group were 14.2±3.2 and 10.5±2.3, respectively, which were significantly lower than the baseline and those in the control group （P〈0.05 for all）. At 1 st and 3rd month after treatment, the itching scores in the control group were 23.6v5.9 and 24.8±6.3, respectively, which were significantly higher than the baseline （P〈0.05）. There was no significant difference in the baseline of serum calcium, phos- phorus, calcium-phosphorus products, iPTH levels between the case group and control group （P〉0.05）. At 3rd month after treatment, serum phosphorus, calcium-phosphorus products and iPTH levels in the case group were decreased significantly as compared with the baseline （P〈0.05）, and the serum calcium, phosphorus, calcium-phosphorus products, and iPTH levels were statistically decreased as compared with those in the control group （P〈0.05）. The AAC scores showed statistically significant difference between the case group and the control group （P〈0.05）. The serum phosphorus and AAC scores showed a positive correlation in both two groups. It was suggested that the administration of lanthanum carbon- ate in the elderly MHD patients can effectively relieve itching, and simultaneously reduce serum phos- phorus and iPTH levels, resulting in the attenuation of vascular calcification.

温州地区维持性血液透析患者矿物质代谢紊乱情况调查

目的了解温州地区维持性血液透析患者矿物质代谢紊乱情况及相关影响因素。方法收集2013年在温州地区长期维持性血液透析患者血钙、血磷、全段甲状旁腺激素(iPTH)的资料,并根据美国肾脏病协会指南(KDOQI)及中华医学会肾脏病学分会(CSN)制订的《慢性肾脏病矿物质和骨异常诊治指导》计算患者的血钙、血磷、iPTH的达标率,并对相关影响因素进行分析。结果共收集2 227例2013年在温州地区各家透析中心维持性血液透析患者的资料。按KDOQI指南标准,患者血钙、血磷、iPTH的达标率分别为44.90%、46.30%、27.64%,3项均达标者占6.29%;按《慢性肾脏病矿物质和骨异常诊治指导》建议,患者血钙、血磷、iPTH的达标率分别为57.66%、46.30%、61.14%,3项均达标者占16.97%。此外,三级医院维持性血液透析患者的平均血磷水平为(1.67±0.51)mmol/L,血磷达标率49.10%,二级医院患者的平均血磷水平为(1.79±0.53)mmol/L,达标率为43.22%,三级医院维持性血液透析患者的血磷达标率情况优于二级医院。血白蛋白、含钙磷结合剂的使用及透析频率是影响血钙达标的独立相关因素。患者的性别、年龄、活性维生素D的使用、透析龄及透析频率是影响血磷达标的独立相关因素。患者活性维生素D的使用是影响iPTH达标的独立相关因素。结论温州地区维持性血液透析患者矿物质代谢紊乱纠正情况与有关指南的要求仍然存在较大差距;患者性别、营养状态、透析频率、含钙磷结合剂的服用、活性维生素D的使用等是影响维持性血液透析患者矿物质代谢紊乱纠正的主要相关因素。

维持性血液透析患者钙 磷及iPTH三项指标达标状况分析

目的分析维持性血液透析(MHD)患者的钙、磷、全段甲状旁腺激素(iPTH)三项指标达标状况及其对MHD患者贫血、营养状况及血压等临床症状的影响。方法回顾性分析2017年1~12月在安徽医科大学第二附属医院血液透析中心行MHD(透析时间≥12个月)的192例患者临床资料。根据钙、磷、iPTH三项指标达标情况分成3组:一项达标组38例、二项达标组48例及三项达标组16例,比较三组患者血红蛋白(Hb)、血清白蛋白(ALB)及血压的差异。结果以改善全球肾脏病预后组织(KDIGO)指南为标准,本组患者钙、磷、iPTH达标率分别为55.2%、28.6%、59.4%,任意两项(钙和磷、钙和iPTH、磷和iPTH)共同达标率分别为12.6%、36.5%、17.7%,三项共同达标率为8.9%。任意两项指标达标的患者中,Hb、ALB达正常值的比例(54.2%、79.2%)明显高于一项达标组(50.0%、68.4%);三项均达标患者中,Hb、ALB达正常值的比例(87.5%、93.8%)明显高于两项达标组(54.2%、79.2%),差异均有统计学意义(P均<0.05);一项达标、二项达标及三项达标组3组间血压达正常值的比例比较,差异无统计学意义(P>0.05)。结论本中心MHD患者钙、磷、iPTH三项指标中磷达标率及三者均达标率有待进一步提高;钙、磷、iPTH均达标有利于MHD患者肾性贫血及营养状况的改善。