低钙透析液对老年血液透析伴低转化肾性骨病患者的影响

摘要

目的 通过前瞻性随机对照研究探讨应用低钙透析液进行血液透析,对老年维持性血液透析(MHD)伴低转化肾性骨病患者钙磷代谢、甲状旁腺功能和血管钙化的影响.方法 选择MHD 6个月以上、病情稳定、连续2次血甲状旁腺激素(iPTH)＜100 ng/L的老年患者80例,随机分为对照组和治疗组各40例;对照组采用含钙1.50 mmol/L透析液,治疗组采用含钙1.25 mmol/L透析液,均治疗12个月.观察并记录治疗前、治疗后1、3、6、12个月时患者血iPTH、校正钙、磷、钙磷乘积等指标的变化以及相关不良反应;检测治疗前和治疗6、12个月时患者颈动脉内膜中层厚度(IMT)、腹主动脉钙化积分(AACS).结果 治疗组治疗1个月后血校正钙、磷和钙磷乘积开始下降,3个月后进一步降低;血iPTH水平1个月后明显升高,3个月后进一步升高;6个月后上述指标趋于稳定,与治疗前比较差异均有统计学意义(P＜0.05).治疗后6个月和12个月时,治疗组平均IMT和AACS较治疗前明显下降,且明显低于对照组(均P＜0.05).对照组治疗期间上述指标与治疗前比较,差异无统计学意义(P＞0.05).两组患者透析过程中,不良反应发生率差异无统计学意义(P＞0.05).结论 对于血iPTH＜100 ng/L老年MHD患者,应用含钙1.25 mmol/L透析液进行血液透析能较好地控制校正血钙、磷、钙磷乘积水平,能有效地改善被过度抑制的甲状旁腺功能和血管钙化状况,并且安全性良好.%Objective To study the effects of low calcium dialysate on the calcium-phosphorus metabolism,parathyroid function and vascular calcifications in elderly patients with low turnover renal osteodystrophy undergoing maintenance hemodialysis (MHD).Methods 80 MHD elderly patients (aged≥60 years) who were in stable condition over 6 months and with two consecutive serum intact parathyroid hormone (iPTH) ＜100 ng/L were observed for 12 months and randomly classified into the control group (calcium 1.50 mmol/L of dialysate,n=40) and the treatment group (calcium 1.25 mmol/L of dialysate,n =40).The changes of serum iPTH,calcium,phosphorus,calcium and phosphorus product and other indicators as well as related adverse reactions were observed and recorded before and 1,3,6 and 12 months after treatment.In addition,the intima-media thickness (IMT) of carotid artery and abdominal aorta calcification score (AACS) were measured in the patients before and 6 and 12 months after treatment.Results In the treatment group,serum corrected calcium,phosphorus,and calcium-phosphate product began to decline after 1 month and a further decline at 3 months later,and serum iPTH level was significantly increased after 1 month and gradually increased at 3 months later.The above markers were stabilized after 6 months of treatment,and there were significant differences in the changes of the above markers before and after treatment (all P＜0.05).Average IMT and AACS in the treatment group were significantly decreased at 6,12 months as compared with pre-treatment,and were lower than that in control group after treatment (all P＜0.05).There were no significant differences in above laboratory indexes in control group before versus after treatment.There was no significant difference in the adverse reactions between two groups (P＞ 0.05).Conclusions The low calcium dialysate (1.25 mmol/L) can prominently control the levels of serum calcium,phosphorus and calcium phosphorus product,effectively improve the over suppressed parathyroid function and vascular calcifications,and has a good security in elderly MHD patients with serum iPTH concentration ＜100 ng/L.