EFFECTS OF HIGH DIALYSATE CALCIUM CONCENTRATION ON BONE REMODELING, SERUM BIOCHEMISTRY, AND PARATHYROID-HORMONE IN PATIENTS WITH RENAL OSTEODYSTROPHY
EFFECTS OF HIGH DIALYSATE CALCIUM CONCENTRATION ON BONE REMODELING, SERUM BIOCHEMISTRY, AND PARATHYROID-HORMONE IN PATIENTS WITH RENAL OSTEODYSTROPHY
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DOI：
10.1038/ki.1977.40
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发表时间：
1977-01-01
影响因子：
19.6
通讯作者：
MARIE, P
中科院分区：
文献类型：
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作者：
DRUEKE, T;BORDIER, PJ;MARIE, P
在6例接受间歇性血液透析的肾性骨营养不良患者中，研究了透析液钙浓度8.0 mg/100 ml（治疗阶段2）与7.0 mg/100 ml（治疗阶段1）对血浆钙、磷、血清免疫反应性甲状旁腺激素（iPTH）、骨组织学、肠道钙吸收和钙跨透析膜转移的影响。在第1和第2阶段，透析前后血浆Ca的变化无显著差异。与平均透析前水平相比，在这两个阶段观察到平均透析后血浆Ca水平显著升高。透析前血浆钙和血液透析期间血浆钙的增加之间存在显著的负相关关系。在6例患者中的4例中测定了透析后状态下钙穿过透析膜的转移和肠道钙吸收分数。在第2阶段，所有4例患者的钙转移均较高，但与第1阶段相比，仅1例患者的肠道钙吸收中度升高，其余3例患者的肠道钙吸收显著降低。尽管升高至8.0 mg/100 ml，但该较高透析液Ca仅显著降低了6例患者中1例的血清iPTH水平;在该患者中，破骨细胞计数、主动吸收表面和骨膜细胞性骨质溶解减少。在第2例患者中，虽然血清iPTH水平似乎明显降低，但骨细胞和骨细胞吸收没有变化。在其余4例患者中，血清iPTH水平不变，骨吸收参数不变或加重。提供额外的钙（使用8.0 mg/100 ml的透析液钙浓度），其目的是减少继发性甲状旁腺功能亢进，证明仅在1例患者中成功，在其他5例患者中失败。3例继发性甲状旁腺功能亢进加重。在研究的6名患者中，5名患者使用8.0 mg/100 ml透析液钙浓度与7.0 mg/100 ml相比没有任何优势。
The influence of a dialysate Ca concentration of 8.0 mg/100 ml (treatment period 2) vs. 7.0 mg/100 ml (treatment period 1) on plasma Ca, P, serum immunoreactive parathyroid hormone (iPTH), bone histology, intestinal Ca absorption and Ca transfer across the dialysis membrane was investigated in 6 patients with renal osteodystrophy undergoing intermittent hemodialysis. During the periods 1 and 2, the plasma Ca changes before and after dialysis were not significantly different. A significant increase in mean postdialysis plasma Ca level was observed during both periods when compared to mean predialysis level. A significant, inverse relation was found between predialysis plasma Ca and the increase in plasma Ca during hemodialysis runs. Ca transfer across the dialysis membrane and fractional intestinal absorption of Ca in the postdialysis state were determined in 4 of the 6 patients. During period 2, Ca transfer was higher in all 4 patients but intestinal Ca absorption was moderately higher only in 1 and strikingly lower in the remaining 3 patients when compared to period 1. Although brought up to 8.0 mg/100 ml, this higher dialysate Ca significantly decreased the level of serum iPTH only in 1 of the 6 patients; in this patient, osteoclast count, active resorption surface and periosteocytic osteolysis decreased. In a 2nd patient, although the level of serum iPTH seemed to decrease markedly, osteoclastic and osteocytic resorption did not change. In the remaining 4 patients, the level of serum iPTH was unchanged and bone resorption parameters were found unchanged or aggravated. Providing additional Ca (using a dialysate Ca concentration of 8.0 mg/100 ml), the goal of which was to decrease secondary hyperparathyroidism, proved to be successful only in 1 patient and failed to do so in the 5 others. Secondary hyperparathyroidism was aggravated in 3 of them. The use of a dialysate Ca concentration of 8.0 mg/100 ml did not result in any advantage over that of 7.0 mg/100 ml in 5 of 6 patients studied.