高通量血液透析治疗老年尿毒症患者钙磷代谢异常的临床疗效

目的探讨高通量血液透析对老年尿毒症患者钙磷代谢异常的临床疗效。方法选取老年尿毒症患者钙磷代谢异常患者146例,随机数字表法分为观察组和对照组各73例。对照组给予低通量血液透析治疗,观察组给予高通量血液透析治疗,两组均治疗6个月。对两组治疗前后血磷、血钙、血肌酐及血甲状旁腺素水平变化及不良反应发生情况进行观察。结果治疗前两组患者血磷、血钙、血肌酐和血甲状旁腺素水平均无明显差异(P0.05),治疗后两组血磷、血钙、血肌酐和血甲状旁腺素水平差异显著(P0.05);治疗期间,两组患者均无明显不良反应发生。结论高通量血液透析可显著改善老年尿毒症患者钙磷代谢异常,无明显不良反应,安全有效,值得推广。     

高通量滤器干预对维持性血液透析患者钙、磷、甲状旁腺的代谢调节作用

目的:探讨高通量滤器干预对维持性血液透析患者血清钙、磷以及甲状旁腺素水平的影响。方法:48例维持性血液透析患者改用高通量滤器透析治疗3个月为高通量组,另48例采用低通量滤器干预维持血液透析患者作为低通量组。比较2组血清钙、磷、全段甲状旁腺素(i PTH)水平的差异。结果:与低通量组比较,高通量组患者血钙水平显著升高,血磷、甲状旁腺素水平明显降低(均P0.05),高通量组血清钙2.10~2.50 mmol/L、血清磷0.81~1.45 mmol/L、i PTH 130~600 ng/L达标控制率显著高于低通量组(P0.05)。结论:高通量滤器透析能够有效改善尿毒症维持性血液透析患者钙、磷、甲状旁腺代谢紊乱,值得在临床中推广应用。     

四种血液透析对维持性血液透析患者肾性骨病相关因素血钙、血磷、甲状旁腺激素等的临床研究

目的探讨普通血液透析、血液透析滤过、血液滤过、高通量血液透析对维持性血液透析患者肾性骨病相关因素血钙、血磷、甲状旁腺激素等的影响。方法选取2014年7月~2016年4月我院肾性骨病血液透析患者76例,根据透析方式不同分为A组(普通血液透析)、B组(血液透析滤过)、C组(血液滤过)、D组(高通量血液透析),各19例,比较各组透析前后血钙、血磷、甲状旁腺激素、血清白蛋白水平下降率及不良反应发生情况。结果透析后B、C、D组血钙、血磷、甲状旁腺激素水平下降率优于A组,C、D组血磷、甲状旁腺激素水平下降率优于B组,差异具有统计学意义(P0.05)各组间透析后不良反应发生情况对比,差异无统计学意义(P0.05)。结论高通量血液透析可有效改善维持性血液透析肾性骨病患者血钙、血磷、甲状旁腺激素水平。     

不同血液净化方式对维持性血液透析患者残余肾功能的影响

目的探讨不同血液净化方式对维持性血液透析(MHD)患者残余肾功能(RRF)的影响。方法选择2012年1月至2014年1月该院行MHD治疗的尿毒症患者80例,根据随机数字表法分为高通量组及低通量组,各40例。高通量组采取高通量血液透析器治疗,低通量组采取低通量血液透析器治疗,观察2组治疗前及治疗后6个月RRF、甘油三酯(TG)、胆固醇、血磷水平。结果 2组治疗前RRF对比无明显差异(P0.05);治疗6个月后,高通量组RRF水平显著高于低通量组(P0.05)。2组治疗前TG、胆固醇、血磷水平对比无明显差异(P0.05);治疗6个月后,高通量组TG、胆固醇、血磷显著低于低通量组,且低于治疗前(P0.05)。结论高通量血液透析可以有效清除大分子毒素,降低血脂、血磷水平;相较于低通量血液透析,高通量血液透析对RRF的保护作用更佳。     

低钙透析联合磷结合剂对血液透析患者钙磷代谢紊乱和冠状动脉钙化的影响

目的探讨低钙透析联合磷结合剂对血液透析患者钙磷代谢紊乱和冠状动脉钙化的影响。方法 80例伴冠状动脉血管钙化并行维持性血液透析(MHD)患者按照随机数字表法分为对照组和研究组各40例;对照组采取标准钙透析液及醋酸钙口服治疗,研究组采取低钙透析联合醋酸钙治疗,两组均进行12个月治疗;治疗前、治疗3、6、12个月后对血清钙、磷、甲状旁腺素进行检测,并采用螺旋CT对冠状动脉钙化积分进行检查。结果两组治疗前血清钙、磷及甲状旁腺素水平比较无明显差异(P>0.05)。研究组治疗3、6、12个月后血清钙及磷水平均明显低于对照组,而甲状旁腺素水平明显高于对照组(P<0.05);两组治疗前冠状动脉钙化积分比较无明显差异(P>0.05);研究组治疗3、6、12个月后冠状动脉钙化积分均明显低于对照组(P<0.05)。结论低钙透析联合含钙的磷结合剂可有效纠正钙磷代谢紊乱,延缓冠状动脉钙化进展,有效降低甲状旁腺功能亢进的发生率,适用于伴冠状动脉血管钙化的血液透析患者。     

MHD患者钙磷代谢和甲状旁腺功能的变化

目的 探讨维持性血液透析(MHD)患者钙磷代谢和甲状旁腺功能的变化.方法 选择476例MHD患者,观察透析前患者钙、磷、钙磷乘积及全段甲状旁腺激素(iPTH)等水平,并与美国肾脏病基金会慢性透析患者骨代谢和疾病临床实践指南中的要求进行比较.结果 476例MHD患者血磷水平为(1.63±0.41) mmol/L,达标者261例(54.8％);校正血钙水平为(2.30±0.31)mmol/L,达标者273例(57.4％);钙磷乘积为(51.35±12.46)mg2/dL2,达标者351例(73.7％);血iPTH水平为(185.5 ±126.3) ng/L,达标者为145例(30.5％).血钙、血磷、钙磷乘积和iPTH单项达标者372例(78.2％),2项达标者262例(48.7％),3项达标者138例(29.0％),4项达标者79例(16.6％).结论 MHD患者普遍存在钙磷代谢紊乱和甲状旁腺功能异常,应当予以重视.     

维持性血液透析患者血管钙化及相关因素分析

目的观察维持性血液透析(MHD)患者血管钙化情况及其影响因素,探讨矿物质与骨代谢指标在MHD患者血管钙化中的作用。方法选取MHD患者69例和健康体检者67例,检测血清白蛋白、血清总钙、血磷、血肌酐、碱性磷酸酶、钙磷乘积和全段甲状旁腺激素(i PTH)。同时行侧位腹平片(空腹)、髋关节正位片、双手及腕关节正位片X线检查以评价腹主动脉、股动脉、桡动脉及双手动脉钙化情况,并了解钙化与相关因素之间的关系。结果 MHD组血管钙化程度明显高于正常对照组(P0.05);中重度钙化组年龄、透析时间、血糖、血磷和钙磷乘积均高于轻度钙化组(P0.05);低i PTH(150 ng/L)、高i PTH(300 ng/L)患者i PTH与钙化相关(P0.05),150~300 ng/L i PTH患者i PTH与钙化无相关性(P0.05)。结论年龄、透析时间、血磷、血糖、钙磷乘积、i PTH水平可能与MHD患者血管钙化密切相关。     

透析前注射左卡尼汀对透析耐受性差维持性血液透析患者蛋白质能量消耗及钙磷代谢的改善状况分析

目的分析透析前与透析后注入左卡尼汀对透析耐受性差的维持性血液透析(MHD)患者钙磷代谢紊乱、甲状旁腺激素亢进及蛋白质能量消耗(PEW)改善情况,为提高MHD患者生活质量提供依据。方法选取2003年1月至2016年12月在贵州省人民医院和贵阳市第一人民医院18~75岁透析耐受性差的维持性血液透析患者共50例。将其随机分成两组,将透析前使用左卡尼汀的25例患者作为观察组,透析结束时使用左卡尼汀的25例患者作为对照组。观察组在每次血液透析前15 min从内瘘静脉端注入左卡尼汀1 g,对照组在患者透析结束时注入相同剂量的左卡尼汀,两组患者每周透析3次,随访共3个月。采用治疗前后两组间比较及各组治疗前后自身对照比较评估两种给药方法对患者PEW、钙磷代谢、透析充分性等改善情况有无差异。结果给药3个月后,PEW相关指标比较,治疗后观察组前白蛋白、白蛋白及瘦体重较对照组明显升高,低密度脂蛋白胆固醇、C反应蛋白(CRP)降低,差异有统计学意义(P0.05);对照组治疗后仅有三酰甘油明显下降,其余各指标变化差异均无统计学意义(P0.05)。钙磷代谢及透析充分性指标比较,治疗后观察组血钙和Kt/V值较对照组明显升高,血磷、甲状旁腺激素、肌酐明显降低,差异有统计学意义(P0.05)。结论 MHD患者透析前补充左卡尼汀,与透析后给药相比,更能有效改善患者PEW、全身系统性炎症、钙磷代谢紊乱及甲状旁腺功能亢进,提高透析充分性及患者透析耐受性,改善生存质量。     

高通量滤器干预维持血液透析患者后血清钙、磷、甲状旁腺激素的变化分析

目的：探讨高通量滤器干预维持血液透析患者后钙、磷以及甲状旁腺的变化。方法：将48例维持血液透析患者改用高通量滤器透析治疗3个月,比较治疗前后钙、磷、甲状旁腺素(iPTH)水平。所有患者B 超检测甲状旁腺,并分为增生(A组)、非增生(B组)两组进行比较。结果：高通量滤器透析患者血钙显著升高,差异具有统计学意义(P＜0.05),血磷、甲状旁腺素水平明显降低,差异具有统计学意义(P＜0.05),A组效果比B组效果更为显著,差异具有统计学意义(P＜0.05)。结论：高通量滤器透析能够有效改善尿毒症维持血液透析患者钙、磷、甲状旁腺代谢紊乱,值得在临床中推广应用。     

不同钙浓度透析液对高磷血症血液透析患者钙磷代谢和血清胎球蛋白A水平的影响

目的:观察不同含钙离子浓度透析液与不同剂量碳酸钙联用对血液透析患者钙磷代谢和血清胎球蛋白A水平的影响.方法:63例维持性血液透析(MHD)患者随机分为3组,分别采用钙浓度(DCa)为1.75 mmol/L(DCa1.75组)、1.50 mmol/L(DCa 1.50组)、1.25 mmol/L(DCa 1.25组)透析液透析.DCa 1.75、DCa 1.50组患者口服小剂量碳酸钙片或不服碳酸钙片,DCa 1.25组患者口服碳酸钙片3 g,每日3次.每组均透析9个月(为观察终点),每3个月检测血钙、血磷、血清全段甲状旁腺素(iPTH)和胎球蛋白A.结果:观察终点与初始值比较,DCa 1.75组血钙、钙磷乘积和胎球蛋白A明显上升(P＜0.05);DCa 1.50组血磷轻度上升,iPTH均值和胎球蛋白A水平相对平稳;DCa 1.25组血钙水平有所下降,血磷与钙磷乘积显著下降(P＜0.05),iPTH均值和胎球蛋白A水平相对平稳,且发现iPTH在150～300 ng/L间者所占百分比明显增多.结论:对合并高磷血症的MHD患者,使用高钙透析液可使钙磷乘积上升,钙化抑制物胎球蛋白A水平增高,增加了血管钙化的风险;对此采用低钙透析液联用较大剂量碳酸钙口服,不仅iPTH趋于理想范围,且胎球蛋白A水平相对稳定,可有效预防血管钙化的发生.     

血液透析管理

自1943年Kolff首次将透析用于临床以来,血液透析用于治疗终末期肾病至今已有近 80 年历史,2017年估计全球肾衰竭的患病率为0.07％,达到970万例[1],预计到2030年,全世界需要肾脏替代治疗的患者将达到543.9万(389.9万～764.0万)例[2].目前约89％的终末期肾病患者采取的肾脏替代治疗方式...     

Pregnancy and hemodialysis

Pregnancy is a rare occurrence in patients on chronic hemodialysis (CHD). The rate of successful pregnancies amounts to almost 60%, thanks to modifications of the dialysis schedule and a specifically adapted obstetrical and neonatal management. We report on seven pregnancies occurring between 1995 and 2001 in six women with a mean age of 32 years (22-39 years), on HD for a mean period of 36 months (12-96 months). Maternal and fetal complications, and the long-term outcome of mothers and children are reported, and the collaborative approaches adopted by obstetrician, pediatrician and nephrologist are discussed. The frequency and length of HD was systematically increased. One patient chose to terminate her pregnancy at 20 weeks of gestation. The mean gestational age for the six other pregnancies was 31 weeks (24-34 weeks) with an average weight at birth of 1495 g (660-1920 g). One neonate born at 24 weeks died 2 days following delivery. One patient was treated with uterine artery embolization for post-partum haemorrhage. Pediatric evaluation of the five children, who were followed up for a period ranging between 2.5 to 5.5 years, showed a good long-term outcome. In conclusion, pregnancy needs not be counterindicated or systematically terminated in patients on CHD, particularly if transplantation is not possible, if the patient refuses it, or if she is relatively old and there is a long waiting period before transplantation.     

Lipoperoxidation and hemodialysis

It has been suggested that hemodialysis patients may be under increased oxidative stress and may therefore benefit from the long-term use of antioxidants (particularly for the reduction of the risk of heart disease). The aim of this study was, first, to evaluate the effect of hemodialysis by itself on lipid and lipoprotein oxidation profiles and, second, to analyze the effect of vitamin C supplementation in patients with end-stage renal disease starting hemodialysis. Forty-one patients with end-stage renal disease were enrolled and randomized to receive 1000 mg/d vitamin C or matching placebo before starting hemodialysis. We measured lipid profile and the susceptibility of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) to oxidation using copper ions at the moment of inclusion and after 1 year. All lipoperoxidation parameters were included. Hemodialysis by itself improved the lipid profile, lowering total cholesterol (176.4 ± 48.4 to 154.2 ± 28.8 mg/dL, P < .01), LDL cholesterol (94.1 ± 39.6 to 76.1 ± 26.6 mg/dL LDL, P < .03), and phospholipids levels (196.5 ± 36.7 to 182.9 ± 36.1 mg/dL, P < .05) in all patients on maintenance hemodialysis. The HDL cholesterol was also decreased (49.4 ± 19.8 to 43.4 ± 24.1 mg/dL HDL, P < .03). No significant differences were detected between patients receiving vitamin C and those receiving placebo. Thiobarbituric acid reactive substances (TBARS) and lipoperoxides increased in patients after a year of hemodialysis, but the difference was lower in those administered vitamin C for a year—TBARS LDL (in nanograms per gram LDL): 0.25 ± 0.20 to 0.38 ± 0.2 in vitamin C-treated subjects and 0.28 ± 0.17 to 0.46 ± 0.21 in those treated with placebo (P < .007); TBARS HDL (in nanograms per gram HDL): 0.22 ± 0.12 to 0.34 ± 0.30 in patients receiving vitamin C and 0.20 ± 0.18 to 0.28 ± 0.19 in those receiving placebo (P = .071). Hemodialysis by itself seems to improve the lipid profile in patients with a previous prooxidative state such as uremia. Although our results failed to demonstrate significant differences between vitamin C-treated and untreated patients, and despite the small number of patients, the trend toward a decrease in oxidation products due to vitamin C supplementation may be beneficial for oxidation parameters. This area remains controversial and under active investigation. Further research is necessary before a firm conclusion can be reached.