低钙透析液对血液透析患者钙磷代谢的长期影响

目的 观察长期应用钙离子浓度为1.25 mmol/L的低钙透析液(LCaD)对血液透析患者钙磷代谢的影响.方法 本研究共纳入38例稳定透析患者,以1.25 mmol/L钙浓度透析液替换原使用的1.75mmol/L钙浓度透析液(HCaD),回顾性观察使用低钙透析液2年后患者血清钙、磷、钙磷乘积、全段甲状旁腺素(iPTH)等指标的变化.结果 与高钙透析液相比,整体观察,采用低钙透析液后患者血钙水平降低HCaD(2.32±0.23)mmol/L,LCaD(2.21±0.24)mmoI/L;t=2.286,P=0.028],iPTH水平明显升高HCaD(20.92±16.04)pmoL/L,LCaD(40.02±30.55)pmoL/L;t=-4.029,P=0.000],血磷及钙磷乘积变化不明显.按照基点处iPTH水平分组观察,低iPTH组(iPTH＜11.0 pmol/L)患者的血钙水平较前下降HCaD(2.46±0.19)mmoL/L,LCaD(2.11±0.23)mmol/L;t=4.047,P=0.002],钙磷乘积下降HCaD(4.75±1.66)mmol2/L2,LCaD(3.54±0.77)mmol2/L2;t=3.784,P=0.004],血磷保持稳定,iPTH水平中度升高HCaD(5.67±2.84)pmol/L;LCaD(27.72±27.79)pmol/L;t=-2.490,P:0.032].高iPTH组(iPTH≥11.0 pmol/L)患者的血钙、血磷及钙磷乘积未见显著差异,iPTH水平显著升高HCaD(27.15±15.43)pmol/L,LCaD(45.03±30.68)pmol/L;t=-3.138,P=0.004].按照基点处血钙水平分组观察,低血钙组(Ca＜2.10 mmol/L)和正常血钙组(ca 2.10-2.37 mmol/L)患者的钙、磷、钙磷乘积基本保持相对稳定.高血钙组(ca＞2.37 mmol/L)患者的血钙水平下降HCaD(2.52±0.12)mmol/L,LCaD(2.25±0.20)mmol/L;t=4.153,P=0.001],血磷水平保持稳定,钙磷乘积下降HCaD(4.94±1.19)mmol2/L2,LCaD(4.10±0.80)mmol2/L2;t=2.587,P=0.012].iPTH水平于低血钙组保持相对稳定,于正常血钙组HCaD(20.18±11.00)pmol/L;LCaD(37.45±32.61)pmol/L;t=-2.351,P=0.032]和高血钙组HCaD(14.68±12.98)pmol/L,LCaD(40.19±33.20)pmol/L;t=-3.432,P=0.004]均有升高.结论 1.25 mmoL/L钙浓度透析液可应用于多数不同血钙浓度的患者,长期应用低钙透析液可以降低血钙,促进PTH分泌,有利于减少转移性钙化和动力缺失性骨病的发生,但同时增加了继发性甲状旁腺功能亢进的风险.

The long term effect of low calcium dialysate on calcium-phosphate metabolism in hemodialysis patients

Objective To observer the long term effect of 1.25 mmol/L calcium concentrate dialysate (LCaD)on calcium-phosphate metabolism in hemodialysis patients.Methods This study included 38 patients.They were maintained hemodialysis with 1.75 mm01/L calcium concentrate dialysate(HCaD)more than 1 years,and then changed to LCaD for 2 years.Albumin-adjusted seFum calcium,phosphate,calcium x phosphate(Ca×P)product.and intact parathyroid hormone(iPTH)before and after application of LCaD were compared.Results Serum calcium decreasedHCaD(2.32±0.23)mmoL/L,LCaD(2.21±0.24)mmol/L;t=2.286,P=0.028]and iPTH increasedHCaD(20.92±16.04)pmol/,L,LCaD(40.02±30.55)pmol/L;t=-4.029,P=0.000],the phosphate and Ca×P product did not changed obviously.In the low iPTH group(iPTH＜11.Opmol/L),the levels of calciumHCaD(2.46±0.19)mmol/L,LCaD(2.11±0.23)mmol/L;t=4.047,P=0.002]and Ca×P product HCaD(4.75 ±1.66)mmol2/L2,LCaD(3.54±0.77)mmol2/L2;t=3.784,P=0.004]decreased,the iPTH increased moderatelyHCaD(5.67±2.84)pmol/L;LCaD(27.72±27.79)pmol/L;t=-2.490,P=0.032],the serum phosphate keept stable.In the high iPTH group(iPTH≥11.0 pmol/L),the levers of calcium,phosphate and Ca×P product did not changed obviously,but the iPTH lever increased significantlyHCaD(27.15±15.43)pmol/L.LCaD(45.03±30.68)pmol/L; t=-3.138,P=0.004].Observer according the serum calcium at the baseline.the levers of calcium,phosphate and Ca×P product kept stable in the low(Ca＜2.10 mmol/L)and normal calcium(Ca:2.10～2.37 mmol/L)patients.But in the high calcium(Ca＞2.37 mmol/L)patients,the levers of ca]ciumHCaD(2.52±0.12)mmol/L,LCaD(2.25±0.20)mmol/L;t=4.153,P=0.001]and Ca×P product HCaD(4.94±1.19)mmol2/L2.LCaD(4.10±0.80)mmol2/L2;t=2.587,P=0.012]decreased.The iPTH level kept stable in the low calcium patients,but jncreased in the normalHCaD(20.18±11.00)pmol/L;LCaD(37.45±32.61)pmol/L;t=-2.351,P=0.032]and high calciumHCaD(14.68±12.98)pmol/L,LCaD(40.19±33.20)pmol/L;t=-3.432,P=0.004]patients.Conclusion The LCaD could decreased the serum calcium levers and stimulated the PTH secretion.that may reduce the risks of adynamic bone diseases and soft tissue calcifications,but increased the risk of second hyperparathyroidism.