Tumor lysis syndrome: pathogenesis and management

Tumor lysis syndrome refers to the metabolic disturbances (hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia) associated with lymphoproliferative malignancies which occur secondary to cell lysis. In some patients, tumor lysis results in acute renal failure. The nature and severity of the metabolic alterations are variable and may be influenced by the timing and intensity of chemotherapy, the magnitude of cell lysis, and the general condition of the patients with respect to hydration and glomerular filtration rate. Not only do hyperuricemia and hyperphosphatemia result from tumor lysis syndrome, they also contribute to oliguric acute renal failure in patients with tumor lysis. The pathogenesis of tumor lysis syndrome and current therapeutic strategies are discussed.     

Mechanism of induction of hypercalcemia and hyperphosphatemia by lead acetate in the rat

Summary The present study is an investigation of the mechanism of hypercalcemia and hyperphosphatemia induced by the intravenous injection of lead acetate (Pb-Ac). A total of 118 male rats were injected with 30 mg/kg of Pb-Ac, or with 16.5 mg/kg of sodium acetate as the control. The levels of serum calcium, phosphorus and lead were then determined at various time periods after the injections. Serum calcium and phosphorus levels increased with time after Pb-Ac injection and the maximum values of calcium (17 mg%) were found after 1 h and of phosphorus (13.5 mg%) after 30 min. Both calcium and phosphorus levels reverted to the normal range after 12 h. The maximum net rates of increase of calcium and phosphorus were found immediately after Pb-Ac injection. At that time, deposition of lead at the calcifying sites of bone and incisor dentin was demonstrated by a histochemical examination. In other experiments the changes in the calcium and phosphorus contents in the medium after shaking bone powder in serum with Pb-Ac in an in vitro system were studied. It was confirmed that the calcium and phosphorus were displaced from the bone mineral, the extent of the displacement being correlated with the concentration of the Pb-Ac added to the medium, and that these displacements were very rapid reactions. These results suggest that hypercalcemia and hyperphosphatemia following Pb-Ac injection results from a direct action of lead on the bone mineral.     

血液透析患者高磷血症的治疗

目的 比较醋酸钙和碳酸钙治疗血液透析患者高磷血症的疗效及安全性。方法 采用醋酸钙或碳酸钙治疗血液透析并高磷血症患者8周,共60例。测定服用药物治疗前后血钙、血磷及甲状旁腺素并观察不良反应。结果 醋酸钙和碳酸钙降磷作用分别于治疗2周和4周后出现,治疗8周时两者的降血磷作用分别为醋酸钙组由(2.32±0.68)mmol/IJ降为(1.72±0.59)mmol/L(P<0.01),碳酸钙组由(2.29±0.71)mmol/L降为(1.75±0.70)mmol/L(P<0.05),醋酸钙组和碳酸钙组消化道反应发生率分别为23％和27％(P>0.05);高钙血症发生率分别为7％和17％(P<0.01);两组血PTH于治疗前后无显著变化。结论 醋酸钙与碳酸钙相比具有相同的降磷效果和胃肠道副作用,但醋酸钙起效较快,导致高钙血症发生率低,是治疗血液透析患者高磷血症有效、安全的药物。     

血液透析并发高磷血症患者相关问题认知状况的调查分析及护理对策

目的：了解血液透析患者并发高磷血症相关问题的认知状况,进一步分析存在的问题,并采取相应的护理策略。 方法：运用自行设计的血液透析患者并发高磷血症相关问题的调查表对本院58例维持性血液透析并发高磷血症患者行问卷调查。 结果：调查结果显示存在问题：服药不规范;不能严格控制饮食结构及量;对血透并发高磷血症相关知识较缺乏;希望得到医护人员的相关知识指导。 结论：应针对存在的问题采取相应的强化护理措施,提高饮食、服药的依从性,减少和控制高磷血症的发生率,提高患者的生活质量,改善预后。     

不同血液净化方式对慢性肾脏病矿物质和骨异常的临床研究

目的观察2种不同血液净化方式对维持性血液透析患者高血钙、高血磷、高血清甲状旁腺激素、皮肤瘙痒的改善效果。方法选择该院2012年4月至2013年4月进行维持性血液透析且病情稳定患者18例,随机分为单一组和联合组,各9例;单一组采用血液透析滤过（HDF）治疗,联合组采用血液透析（HD）联合血液灌流（HP）治疗。分别在治疗前及治疗后2周检查患者血钙、血磷、钙磷乘积和全段甲状旁腺激素（iPTH）。结果治疗2周后两组患者血钙均有所上升,血磷、iPTH均有所下降,与治疗前比较,差异均有统计学意义（P〈0.05）;此外,联合组患者血磷及iPTH清除率均明显大于单一组,差异均有统计学意义（P〈0.05）。结论 HDF和HD联合HP均能有效清除血磷和iPTH,但HD联合HP更有效。     

Chronic Hemodialysis Patients Without Marked Elevation of Intact Parathyroid Hormone Are Also Good Candidates for Early Intervention With Cinacalcet

Management of calcium (Ca) and phosphorus (P) metabolism is crucial in chronic hemodialysis (HD) patients. Cinacalcet is usually used for chronic kidney disease‐mineral and bone disorders (CKD‐MBD) patients with elevated intact parathyroid hormone (iPTH) levels. However, a certain number of CKD‐MBD patients have normal iPTH levels and are not subjected to cinacalcet therapy. Here, we evaluated the efficacy of a new treatment algorithm of early initiation of cinacalcet therapy in this subgroup of patients, mainly for correcting Ca and P metabolism. Seventy‐one HD patients, including 44 patients without marked elevation of iPTH (102 < iPTH ≤ 300 pg/mL), who received cinacalcet therapy, were enrolled in this study. Serum parameters relating to CKD‐MBD patient metabolism, doses of phosphate binders, and type of vitamin D sterols were compared between pre‐ and post‐cinacalcet administration retrospectively. Sixty‐four of 71 patients did not require discontinuation of cinacalcet. In these 64 patients, serum Ca (P = 0.0003), P (P = 0.0153), and iPTH (P < 0.0001) levels were significantly reduced after cinacalcet administration, even in those without marked elevation of iPTH (Ca; P < 0.0001, P; P = 0.0422, and iPTH; P = 0.0018). The proportion of patients who received vitamin D sterols was unchanged (P = 0.5930) but the proportion of patients who received maxacalcitol was significantly reduced after cinacalcet administration (P = 0.0108). The new treatment algorithm of early initiation of cinacalcet is considered to be well tolerated and effective for controlling hypercalcemia, and/or hyperphosphatemia and/or increased iPTH of CKD‐MBD patients.     

Treating hyperphosphatemia – current and advancing drugs

Introduction: Hyperphosphatemia is a hallmark of advanced chronic kidney disease (CKD) and associated with adverse outcomes. Preclinical and epidemiological studies strongly support a causal relationship between hyperphosphatemia and mortality as well as cardiovascular complications, especially including vascular, valvular and soft-tissue calcifications. Thus, appropriate phosphate lowering is considered to play a major role in health and longevity of CKD patients. In this respect, phosphate binders are the most powerful therapeutic option, while dietary phosphate restriction and intensified dialysis are valuable supportive approaches.

Areas covered: Pubmed was the primary research platform. This search focused on novel phosphate lowering compounds, including iron-containing binders and phosphate transport inhibitors, which have just become available or are in the approval process. Further, additional reports on effective strategies to counteract the adverse consequences of resistant hyperphosphatemia were also collected.

Expert opinion: New iron-containing drugs may offer advantages, including iron supplementation, low pill burden and high efficacy. Phosphate transport inhibitors possess a high potential as add-on compounds in patients with insufficient phosphate binder therapy. One unsolved question remains at what CKD stage to start therapeutically counteracting phosphate retention.     

低钙透析液联合鲑鱼降钙素治疗血透患者高磷血症的临床研究

目的 观察低钙透析液联合鲑鱼降钙素对血透患者高磷血症的影响.方法 选取近期维持性血液透析患者中高磷血症患者40例,随机分为对照组和实验组各20例,对照组用正常钙透析液(钙离子浓度为1.5 mmol)配合碳酸钙和活性维生素D3治疗.实验组用低钙透析液(钙离子浓度为1.25 mmol)联合鲑鱼降钙素注射液同时服用碳酸钙和活性维生素D3治疗.观察治疗后第1、3、6个月时患者的血钙、血磷、钙磷乘积以及全段甲状旁腺激的水平.结果 对照组透析后,与透析1个月比较,6个月血钙、血磷、钙磷乘积均轻度增高(P＜0.05),而iPTH水平无明显变化(P＞0.05);实验组透析后,与透析1个月比较,3个月血钙、血磷、钙磷乘积均轻度减低(P＜0.05),而iPTH水平明显增高(P＜0.05);6个月血钙、血磷、钙磷乘积均轻度减低(P＜0.05),而iPTH水平趋于稳定(P＞0.05);与对照组比较,实验组患者3个月血磷、钙磷乘积均轻度减低(P＜0.05),而iPTH水平明显增高(P＜0.05);实验组患者6个月血磷、钙磷乘积、iPTH均轻度减低(P＜0.05).结论 低钙透析液联合鲑鱼降钙素治疗HD患者能有效的维持血磷水平,降低钙磷乘积,而不致影响iPTH.     

“一护一患”护理模式对维持性血液透析患者钙磷代谢的影响

目的探讨"一护一患"护理模式对维持性血液透析(MHD)患者钙磷代谢的影响。方法随机抽取在本院正规血液透析3个月以上稳定的MHD患者100例为研究对象,研究之初断面统计患者的血钙、血磷、血甲状旁腺激素(PTH)水平、钙磷乘积。随后对这100例患者以"一护一患"的护理管理模式进行管理,随访并指导半年,护理干预结束时再次统计患者的血钙、血磷、血PTH水平、钙磷乘积情况,并进行前后自身对照统计分析。结果经过"一护一患"护理管理后血液透析患者的血磷水平显著低于护理干预前[(1.80±0.28)mmol/Lvs(2.09±0.44)mmol/L]、钙磷乘积水平显著低于护理干预前[(3.88±0.85)mmol2/L2vs(4.63±1.20)mmol2/L2、血PTH水平显著低于护理干预前[(238.36±33.86)pg/mlvs(314.69±43.26)pg/ml],差异均有统计学意义(P<0.05);血钙水平与护理干预前差异无统计学意义[(2.17±0.23)mmol/Lvs(2.20±0.24)mmol/L,P>0.05)]。结论 "一护一患"护理管理模式可以显著改善维持性血液透析患者的钙磷代谢,纠正血液透析患者的高磷、高PTH血症及高钙磷乘积状态。