长期低钙透析对持续性不卧床腹膜透析患者钙、磷、甲状旁腺素水平的影响

目的观察长期应用低钙透析液配合口服碳酸钙及活性维生素D3对持续性不卧床腹膜透析(CAPD)患者血钙、磷、甲状旁腺素(iPTH)水平的影响。方法对第四军医大学西京医院2003-03~2005-06收治的68例慢性肾衰患者使用低钙透析液(Ca2 1·25mmol/L),采用CAPD方式,每日交换透析液均在6L以上。透析1个月后根据化验结果调整碳酸钙和活性维生素D3的服用剂量。观察透析前及透析后1、2、3、6、9、12、18个月血钙(校正的血清总钙)、血磷、iPTH等指标变化。结果透析前血钙(2·28±0·25)mmol/L,血iPTH(163·9±78)ng/L,血磷(1·16±0·13)mmol/L。采用低钙透析液行CAPD治疗1个月后患者血钙水平较透前下降(1·97±0·44)mmol/L(P<0·05),血iPTH明显增加(P<0·001);血磷水平无明显变化(1·11±0·32)mmol/L(P>0·05),碱性磷酸酶和血浆白蛋白水平保持稳定。加服或增加碳酸钙和活性维生素D3的剂量治疗2个月后,血钙水平回升,iPTH下降,接近透前水平(P>0·05),血磷水平保持稳定。连续观察至18个月,54例患者钙、磷水平维持相对稳定,未发现明显的高钙血症及高磷血症,血iPTH水平保持不变。结论(1)长期进行低钙透析(Ca2 1·25mmol/L)可以导致CAPD患者血清iPTH水平增加,配合口服碳酸钙及活性维生素D3可以很好地纠正并维持血iPTH水平,防治高磷血症,避免高钙血症及负钙平衡。     

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.     

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。     

肾移植术后高钙血症的发生率及危险因素

目的:探讨肾移植术后1年内高钙血症的发生率及危险因素,并观察血清钙的演变特点。方法:选取从2013年11月至2015年3月在南京军区南京总医院肾脏科行肾移植手术的受者115例,分别于肾移植术前、术后1个月、3个月、6个月、12个月检测血清钙、全段甲状旁腺激素(iPTH)等矿物质和骨代谢指标。结果:肾移植术后受者血清钙逐步升高,高钙血症的发生率在术后3个月时达到最高值42.6%,随后逐步下降,至术后12个月时为39.1%。患者所有随访时间点的血清钙均3.0 mmol/L。多因素线性回归分析显示术前高iPTH、术后6个月时低磷血症和高碱性磷酸酶是术后6个月时高钙血症的危险因素,术前透析时间长和术前高iPTH是术后12个月时发生高钙血症的危险因素。结论:肾移植术后1年内30%~40%的受者可出现高钙血症。术前高iPTH是术后6个月和12个月时高钙血症的危险因素。监控术前iPTH有助于术后高钙血症的预防和治疗。     

透析液钙离子浓度对维持性血液透析患者血全段甲状旁腺激素的影响

目的评价不同钙离子浓度的透析液对维持性血液透析(MHD)患者血全段甲状旁腺激素(iPTH)的影响,分析血钙、磷和钙磷乘积与iPTH之间的相关性。方法对2006年1月至3月,上海交通大学医学院附属新华医院肾内科门诊35例长期使用钙离子浓度为1·75mmol/L的透析液进行维持性血液透析的患者,于透析前留取血标本进行血Ca2 、P3-、iPTH测定,并计算钙磷乘积后,改为钙离子浓度为1·25mmol/L或1·50mmol/L的透析液进行维持性血液透析,3个月后于透析前再次留取血标本进行血Ca2 、P3-、iPTH测定,并计算钙磷乘积。结果与使用钙离子浓度为1·75mmol/L透析液比较,使用钙离子浓度为1·25mmol/L或1·50mmol/L透析液3个月后,MHD患者血Ca2 、P3-、钙磷乘积差异无显著性意义,P>0·05,血iPTH明显升高,P<0·01。血iPTH与Ca2 呈显著性负相关,r=-0·45,P<0·01;与P3-及钙磷乘积无相关性,r分别为0·13和-0·03,均P>0·05。结论1·25mmol/L或1·50mmol/L的低钙透析液可以升高MHD患者血清iPTH水平。     

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.     

低钙腹透液对持续性腹膜透析患者高钙血症的影响

目的 观察低钙腹透液（PD4,钙离子浓度为1.25 mmol/L）对高钙血症持续性腹膜透析（CAPD）患者钙磷代谢的影响.方法 45例使用标准钙腹透液（PD2,钙离子浓度为1.75 mmol/L）后出现高钙血症的CAPD改用PD4透析,监测患者治疗前后血钙、磷、全段甲状旁腺激素（PTH）的变化,同时分析影响血钙水平变化的相关因素.结果 完成6个月观察的41例患者2个月后即出现血钙、磷水平明显降低,PTH较前明显升高（P＜0.05）.血钙下降幅度与患者的年龄呈负相关,而与透析剂量和超滤量呈正相关（P＜0.05）.结论 PD4可有效调节CAPD患者的高钙血症,缓解低转运性骨病的发生和发展.     

低钙透析液对于持续性非卧床腹膜透析老年患者动力缺失性骨病的疗效分析

目的对患有动力缺失性骨病（ABD）的老年维持性腹膜透析患者使用低钙透析液,观察其提高全段甲状旁腺激素（iPTH）和对钙磷代谢的影响,评估其对老年腹膜透析患者ABD治疗的疗效和安全性。方法选择患有ABD的老年腹膜透析患者（年龄〉60岁,iPTH〈100μg／L）24例,使用低钙腹膜透析液（百特PD4,钙1．25mmol／L）治疗,回顾分析治疗18个月中患者血iPTH、血钙、血磷、钙磷乘积及骨密度、碱性磷酸酶（AKP）等指标变化情况。结果使用低钙透析液治疗后,第1个月血iPTH水平开始上升,第2个月血iPTH水平与治疗前比较明显上升[（131．10±75．78）vs（46．16±22．58）ng／L,P〈0．01],第6,9,12月逐步上升,在第12至18个月中保持稳定,并在目标安全范围内（150-300ng／L）。在12个月内iPTH水平上升至150-300ng／L的患者所占比例随着时间推移逐渐增加,第2,6,9,12个月分别为53．5％,57．2％,66．7％,72．9％;到12个月以后,达标率无明显变化（第15个月和第18个月分别为71．6％和73．3％）。治疗后第2个月血钙、血磷水平以及钙磷乘积与治疗前比较均明显下降【血钙：（2．12±0．18）VS（2．60±0．21）mmol／L,血磷：（1．43±0．49）vJ（1．96±0．53）mmol／L,钙磷乘积：（48．79±20．03）vs（63．36±19．14）mg2／d12;P〈0．01];治疗后AKP由治疗前（107±72）IU／L升高至（176±89）IU／L（P〈O．05）。治疗前后骨质疏松发生率增加12．5％。治疗中无严重低钙抽搐、精神状态改变、低血压和骨折等情况发生。结论对ABD的老年腹膜透析患者使用低钙透析液能有效升高其iPTH水平、改善钙磷代谢,从而达到治疗ABD的目的,治疗安全性较好;但是骨质疏松症发生率有所增高,提示老年腹膜透析患者在治疗ABD的同时,需要加强防治骨质疏松。     

低钙透析液对血甲状旁腺素及钙磷代谢的影响

目的:研究应用钙离子 1 .25mmol/L透析液进行透析 3个月对患者iPTH及钙磷水平的影响。　方法:维持性血液透析患者 6例,试验前用钙离子 1. 5mmol/L透析液每周透析 3次,每次透析 4h,均使用F6透析器(聚砜膜,面积 1 3m2 )。使用钙离子 1 25mmol/L透析液透析 3.个月,此期患者饮食中钙磷的摄入量稳定,用药不变。使用钙离子 1 25mmol/L透析液之前检测透析前血iPTH,透析前后血钙和血磷浓度。3个月后复查透析前血iPTH,透析前后血钙和血磷浓度,并检测使用钙离子 1. 25mmol/L透析液单次透析前、透析后及下一次透析前的血iPTH和血钙、血磷浓度。　结果:单次透析使用钙离子浓度 1 25mmol/L的透析液透析 4h,透后血钙浓度下降,透后血iPTH[ (219 .2±143. 3)ng/L]较透前[ (157. 5±107 .1)ng/L]明显升高 (P<0. 05),至下次透析前血钙浓度及血iPTH(157. 7±125 .3ng/L)基本恢复至上次透析前水平。使用钙离子 1 25mmol/L透析液透析 3个月后,iPTH水平较未使用时明显上升[ (157. 5±107 .1)ng/Lvs(82. 5±43 .7)ng/L,P<0 .05]。　结论:单次应用钙离子 1 .25mmol/L透析液进行透析, 透后血iPTH升高,但是至下一次透前血iPTH基本恢复至上次透前水平。长期应用 ( 3个月)钙离子 1 25mmol/L透析液进行透析,钙负荷减轻,血iPTH水平升     

口服冲击与每日口服1α(OH)D3治疗血液透析患者继发性甲状旁腺功能亢进的临床观察

目的探讨1α(OH)D3治疗血液透析患者继发性甲状旁腺功能亢进(甲旁亢,SHPT)的剂量,并比较口服冲击与每日口服两种方法的疗效及对钙、磷水平的影响.方法根据血清全段甲状旁腺激素(iPTH)水平将34例iPTH<200 ng/L的维持性血透患者随机分为口服冲击组及每日口服组.根据血清iPTH水平确定1α(OH)D3治疗的每周总剂量.以iPTH<200 ng/L作为观察终点,比较治疗前及治疗后4、8周的iPTH、血钙及磷的变化.结果 (1)34例患者治疗前血清iPTH为(686.07±283.65)ng/L,1α(OH)D3剂量为(5.44±4.38)μg/周,治疗8周时iPTH总达标率为82.35%;(2)与每日口服组比较,口服冲击治疗起效快,并对治疗前iPTH>500 ng/L的患者具有更高缓解率(100%比40%,P<0.05);(3)治疗中两组患者的血钙、磷水平均有上升,以每日口服组较为明显,其中13例需采用1.25 mmol/L钙透析液纠正透后高血钙,2例每日口服治疗组患者(5.9%)出现透析前高钙血症需减少1α(OH)D3用量.结论口服1α(OH)D3可有效治疗维持性血透患者SHPT.口服冲击治疗起效快,控制率高,高钙血症发生率低,优于每日口服治疗,尤其适用于中、重度SHPT患者.     

醋酸钙联合低钙透析液在老年高钙高磷腹膜透析患者中的应用

目的 探讨醋酸钙联合低钙透析液治疗对并发高钙和高磷血症老年腹膜透析患者钙磷代谢状况的影响.方法 选择行CAPD治疗6m以上、病情稳定且伴有高钙、高磷血症的老年患者20例,随机分为对照组（使用含钙1.5 mmol/L透析液＋饮食控制）和治疗组（使用含钙1.25 mmol/L透析液＋醋酸钙＋饮食控制）,每组10例,分别观察治疗前、治疗后1、3和6个月的血钙、血磷、钙磷乘积、iPTH和相关不良反应.结果 ①共18人完成该临床研究,其中对照组有1人因出现腹透相关性腹膜炎退出研究;试验组有1人因无法耐受服用醋酸钙后出现的恶心、反酸症状而退出试验.②醋酸钙联合低钙透析液治疗组在治疗后第3个月时血钙、血磷及钙磷乘积水平明显降低,血iPTH浓度明显升高,与对照组相比均有统计学差异（P＜0.05）;至第6个月时血钙、血磷及钙磷乘积水平趋于稳定.③两组患者在研究期间除治疗组1人出现肌肉痉挛外,其余患者未见明显不良反应.结论 醋酸钙联合低钙透析液对于合并高钙血症和高磷血症的老年腹膜透析患者具有较好的治疗效果.     

烟酰胺联合碳酸钙对血透患者高磷血症的治疗观察

观察在常规口服碳酸钙降磷无效的患者加用烟酰胺对血液透析患者高磷血症的疗效。方法：给予30例单纯碳酸钙降磷治疗无效或出现血钙水平偏高的维持性血液透析患者加服烟酰胺片,观察治疗前、治疗一个月及三个月时血磷、血钙、钙磷乘积及血清全段甲状腺旁素（iPTH）水平的影响。结果：与治疗前相比,治疗一个月及三个月时血磷水平[（2.135±0.56）mmol/L比（1.826±0.45）mmol/L比（1.721±0.31）mmol/L]、钙磷乘积[（59.517±10.7）mg2/dl 2比（51.513±9.8）mg2/dl 2比（47.123±8.6）mg2/dl 2]明显下降（P〈0.05,P〈0.01）;治疗3个月时62.5%的患者血磷水平达标,烟酰胺对血钙、iPTH水平无明显影响。结论：口服烟酰胺片可有效降低维持性血液透析患者血磷和钙磷乘积,不影响血清钙水平,无增加血管钙化的风险。     

Effect of glycemic control on intact parathyroid hormone level in end stage renal disease patients on maintenance hemodialysis

Aims

We evaluated the relationship between iPTH levels and glycemic control in patients with diabetes and end stage renal disease (ESRD) on maintenance hemodialysis (MHD).

Methods

The study included 98 subjects with ESRD and type 2 diabetes aged 30–75 years who were on MHD. These were divided into two groups – patients with HbA1c >7.0 (53 mmol/mol) (poor glycemic control group) and patients with HbA1c <7.0 (53 mmol/mol) (good glycemic control group). All patients had been on regular bicarbonate haemodialysis for more than 6 months using polysulfone membrane dialyzer; 4 h per episode 3 times/week, with a dialysis fluid of 3.0 mEq/L of calcium concentration. 1-α-(OH)D3 and calcium carbonate were used routinely in all patients. The contribution of each relevant biological parameter to serum iPTH level was assessed using multiple regression test.

Results

Poor glycemic control was associated with reduced serum iPTH level and good glycemic control with higher serum iPTH. The serum HbA1c level was significantly correlated with the serum iPTH level (p = 0.0003).

Conclusions

Glycemic control is a significant determinant of iPTH level in diabetic ESRD patients on MHD.     

Sevelamer hydrochloride improves hyperphosphatemia in hemodialysis patients with low bone turnover rate and low intact parathyroid hormone levels

Sevelamer improves hyperphosphatemia without increasing the calcium load. However, it remains unknown whether sevelamer restores bone metabolism in hemodialysis patients with low bone turnover osteodystrophy and hypoparathyroidism. We investigated the changes in serum intact parathyroid hormone (iPTH) and bone metabolic marker levels after replacing calcium carbonate with sevelamer in these patients. We also conducted stratified analysis based on patient background and multivariate analysis to determine the factors affecting these parameters. During sevelamer replacement therapy, serum calcium and phosphate concentrations, and the calcium phosphate product were measured at 0, 1, 3, and 6 months. Serum iPTH, bone alkaline phosphatase and osteocalcin concentrations were measured at 0 and 6 months. In hemodialysis patients (71 men and 46 women, 63 +/- 12 years old) serum calcium levels and the calcium phosphate product decreased significantly at 1 month. Serum iPTH, bone alkaline phosphatase and osteocalcin levels increased significantly at 6 months. Increases in serum iPTH concentrations were observed in all stratified groups. Significant increases in serum bone alkaline phosphatase and osteocalcin concentrations were found only in the relative hypoparathyroidism group (iPTH levels > or =51.5 pg/mL, the median pretreatment level). Multivariate analysis showed that the factors affecting change in serum iPTH level are baseline serum iPTH, baseline calcium level (> or =9.5 mg/dL), and dialysis duration of 10 years or longer. Sevelamer appears useful for the treatment of hyperphosphatemia in these patients. Particularly, in the relative hypoparathyroidism group, the iPTH secretory response is probably enhanced and bone turnover may have been improved as a result of reducing the calcium load.     

Serum calcium is an independent predictor of quality of life in multiple myeloma

Bone disease is an important feature of multiple myeloma, and hypercalcaemia is a frequent complication of this disease. We examined the association between serum calcium and quality of life (QOL) scores of 686 multiple myeloma patients at the time of diagnosis. Data from two Nordic studies using the EORTC QLQ-C30 questionnaire were analysed by means of linear regression analysis and a curve fitting program. Serum calcium was independently related to appetite loss, nausea/vomiting and physical functioning (P < 0.001) and to cognitive functioning (P = 0.001), i.e. scores reflecting symptoms that are well known in non-malignant hypercalcaemia. In addition, we found a highly significant independent relationship between serum calcium and the scores for fatigue and pain (P < 0.001). Serum calcium appeared to be as strong a predictor for fatigue as the concentration of haemoglobin. A cubic model (y = a + bx3) fitted the data slightly better than the simple linear model (y = a + bx) and suggested worsening QOL scores at levels of serum calcium above 2.5-3.0 mmol/L. Hypercalcaemia in patients with multiple myeloma seems to be associated with the same symptoms as in non-malignant hypercalcaemia. In addition, an increased level of serum calcium may aggravate the pain and fatigue caused by the skeletal disease itself.     

甲状旁腺全切除术治疗10例Sagliker综合征疗效评估

目的 评估甲状旁腺全切除术治疗重症继发性甲状旁腺功能亢进症(SHPT)致Sagliker综合征(SS)的疗效.方法 回顾性分析在我院因SHPT接受甲状旁腺切除术的212例患者中随访3年以上的SS病例.甲状旁腺全切除术疗效判定:术后全段甲状旁腺激素(iPTH)＜150 ng/L为治愈;150～300 ng/L为显效;301～500 ng/L为有效;＞500 ng/L为无效.术后iPTH＞150 ng/L定义为持续性SHPT.术后1周内iPTH＜100 ng/L,以后随访中逐渐上升＞150 ng/L定义为SHPT复发.结果 (1)入选的10例患者中,男4例,女6例,年龄30～54(39.3±10.4)岁.平均透析龄142个月,所有患者都有严重骨关节疼痛,伴进行性面部增大、鸡胸、驼背、髋部骨骼畸形,身高缩短.(2)术前检查:iPTH中位数2000(1800～2863)ng/L;血钙(2.45±0.21)mmol/L,血磷(2.19±0.51)mmol/L,碱性磷酸酶(1189.8±780.0)IU/L.10例患者颈部超声和99Tcm-甲氧基异丁基异腈(MIBI)扫描均证实有增大的甲状旁腺2～4枚.(3)局麻或伞麻下甲状旁腺全切除术.术后结合血钙水平补充钙剂和骨化三醇.(4)术后随访:术后骨痛、肌无力、皮肤瘙痒、失眠、燥热症状明显改善.全部患者术后有低血钙,2例发生一过性声音嘶哑.所有患者术后iPTH显著下降,术后1个月iPTH中位数55.5(10～967)ng/L,较术前显著下降(P＜0.001),其中疗效判定为治愈8例,持续性SHPT 2例(显效1例,无效1例),其中1例于术后第4年死于心力衰竭.长期随访骨骼畸形停止发展,营养不良得到改善,第3年iPTH中位数135(28～390)ng/L(P＜0.001),血钙、血磷和碱性磷酸酶也在达标范围.2例分别于第2年、第3年SHPT复发.结论 甲状旁腺全切除术可以有效治疗SS,改善患者预后,如骨痛消失、骨骼畸形发展停止、改善营养不良.长期随访部分患者iPTH有再升高可能,应该重视监测.

Abstract：

Objective To evaluate the efficacy of the parathyroidectomy (PTX) in the treatment of severe secondary hyperparathyroidism (SHPT) with Sagliker syndrome (SS). Methods A retrospective review was undertaken among 212 SS patients underwent PTX in our hospital and with more than 3 years' follow up. The definitions of the efficacy were based on the postoperative intact parathyroid hormone level (iPTH). "Cure" showed that the iPTH was ＜ 150 ng/L; "marked effectiveness" was 150-300 ng/L; "effectiveness" was 301-500 ng/L;"ineffectiveness" was ＞500 ng/L. The status was defined as persistent SHPT if iPTH was ＞ 150 ng/L after surgery. The status was considered as SHPT recurrence if iPTH was ＜ 100 ng/L in the first week after surgery, and gradually increased and ＞ 150 ng/L with the follow-up. Results ( 1) Ten patients were involved and the average dialysis time was 142 months [male/female: 4/6; age 30-54 (39. 3 ± 10. 4) years]. All patients had severe bone and joint pain, accompanied with progressive facial increases, chicken breast, kyphosis, hip bone deformities, and body height shortening. (2) Preoperative tests: the median of iPTH 2000(1800-2863) ng/L; serum calcium (2. 45 ±0. 21) mmol/L, phosphorus (2. 19 ±0. 51) mmol/L, alkaline phosphatase ( ALP) (1189. 8 ± 780. 0) IU/L. Two to four enlarged parathyroid glands were confirmed by ultrasound and 99Tcm-MIBI parathyroid scintigraphy. ( 3 ) Surgical procedures: local or general anesthesia for PTX. Supplement with calcium and calcitriol implemented low serum calcium after PTX. (4) Follow-up: symptoms, including bone pain, muscle weakness, skin itching, and insomnia, were significantly improved after surgery. Transient hoarseness occurred in 2 cases. The iPTHs of all patients were decreased significantly after surgery. The median of iPTH was 55.5 ( 10-967) ng/L at 1 month post PTX, and was significantly less than prior to PTX (P＜0. 001). Eight patients were "cure" , 1 "marked effectiveness" ,and 1 "ineffectiveness". Two patients were persistent SHPT, and 1 died of heart failure in the 4th year after PTX. The development of bone deformities was stopped and malnutrition was improved in long-time follow up. The level of iPTH 135(28-390)ng/L(P＜0. 001 ) , serum calcium, phosphorus, and ALP showed normal in the third year. The SHPT recurrence was appeared in the 2nd and 3rd year in 2 out of 8 patients, respectively. Conclusions Total PTX can effectively treat SS by SHPT. It can improve prognosis for patients, such as bone pain disappearing, bone deformities stopping and malnutrition improving, etc. The level of iPTH may rise again in some patients in the future. Therefore, more attentions should be paid to monitoring.     

Effects of serum calcium, phosphorous, and intact parathyroid hormone levels on survival in chronic hemodialysis patients in Japan

Disturbances in bone mineral metabolism are common in chronic hemodialysis (HD) patients and often underlie morbid conditions and mortality; however, no large epidemiological study for Asian dialysis patients has been performed. We analyzed the database of the Japanese Society for Dialysis Therapy registry. In this study, data from patients who were on HD at the end of 2000 was compiled. The Cox's proportional hazard analysis was carried out to evaluate the significance of the impact of variables related to bone mineral metabolism on survival after adjusting for possible confounding variables. The study period was three years, and a cohort of 27 404 HD patients was studied. The hazard ratios were 1.098 (P = 0.0129) for serum calcium levels ranging 10.0-10.9 mg/dL, and 1.243 (P = 0.0001) for serum calcium levels >11.0 mg/dL when the reference serum calcium level range was 9.0-9.9 mg/dL. Similarly, the hazard ratios were significantly higher in a serum phosphorous level of 5.0 mg/dL than for the reference serum phosphorous level range of 4.0-4.9 mg/dL. For intact parathyroid hormone (iPTH), the hazard ratios were significantly small (<119 pg/mL) when the reference iPTH level range was 180-359 pg/mL. However, the hazard ratio did not increase when the iPTH level increased to >360 pg/mL. Results showed that disturbances in bone mineral metabolism, such as those involving serum calcium, phosphorous, and iPTH, have a significant impact on survival in Japanese dialysis patients.     

Effects of lowering dialysate calcium concentration on mineral metabolism and parathyroid hormone secretion: a multicentric study

This prospective study was conducted with the aim of examining the efficacy of lowering dialysate calcium (dCa) in order to: (i) stimulate bone turnover in hemodialysis patients with biochemical signs of adynamic bone disease (ABD) (hypercalcemia, normal alkaline phosphatase and intact parathyroid hormone (iPTH) <150 pg/mL); and (ii) diminish hypercalcemia in patients with secondary hyperparathyroidism (sHPT) (hypercalcemia, high alkaline phosphatase and iPTH > 400 pg/mL), thus permitting the use of calcium-containing phosphorus binders and vitamin D metabolites. Patients were divided into: an ABD-treated group (24 patients), a sHPT-treated group (18 patients), an ABD-control group (12 patients) and a sHPT-control group (11 patients). For the ABD- and sHPT-treated patients, hemodialysis was conducted with dCa 1.5 mmol/L for three months and then with dCa 1.25 mmol/L for an additional three months, while in the control groups hemodialysis was conducted with dCa 1.75 mmol/L during the entire study. Reduction of dCa in patients with ABD caused a slight but insignificant decrease of Ca, but a significant and permanent increase of bone-specific alkaline phosphatase and intact parathyroid hormone level serum levels. Reduction of dCa in patients with sHPT slightly but insignificantly decreased Ca and intact parathyroid hormone level values. Nevertheless, this enabled the calcium-based phosphate binder dose to be raised and vitamin D3 metabolites to be introduced. Logistic regression analysis indicated that milder bone disease (both ABD and sHPT) was associated with more the favorable effect of dCa reduction. Thus, low dCa stimulated parathyroid glands and increased bone turnover in ABD patients, and enabled better control of mineral metabolism in sHPT patients.