CALCIUM AND PHOSPHORUS FLUXES DURING HEMODIALYSIS WITH LOW CALCIUM DIALYSATE
CALCIUM AND PHOSPHORUS FLUXES DURING HEMODIALYSIS WITH LOW CALCIUM DIALYSATE
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DOI：
10.1016/s0272-6386(12)80882-1
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发表时间：
1991-08-01
影响因子：
13.2
通讯作者：
BOURDEAU, JE
中科院分区：
文献类型：
--
作者：
HOU, SH;ZHAO, J;BOURDEAU, JE
我们评估了不同透析液钙浓度对成人血液透析患者血浆钙和磷浓度和透析器通量的急性影响。7例稳定的终末期肾衰竭患者每周透析3次，每次4小时。比较了含1.75、1.25或0.75 mmol/L（70.1、50.1或30.1 mg/L）钙的透析液的效果。每例患者在每次浴钙浓度下研究一次。与透析前平均值2.27 mmol/L（9.1 mg/dL）相比，钙透析液浓度为1.75、1.25或0.75 mmol/L时，血浆总钙浓度分别升高、保持不变或降低。0.75 mmol/L钙透析液不会引起低钙血症的体征或症状（血浆钙浓度不会低于1.80 mmol/L [7.2 mg/dL]）。无论透析液钙浓度如何，血浆磷浓度均从透析前平均值2.16 mmol/L（6.7 mg/dL）同等降低。用三种不同透析液处理4小时后，累积钙通量显著不同。当钙浓度为1.75 mmol/L时，平均体内钙蓄积量为21.9 mmol（879 mg）。在1.25 mmol/L时，没有净钙通量。0.75 mmol/L时，患者平均钙丢失为5.8 mmol（231 mg）。4小时后的平均除磷量为32.5 mmol（1，006 mg），不受透析液钙浓度的影响。我们的结论是：（1）在1.75 mmol钙/L的血液透析期间，进入患者的净钙通量是可观的，而在0.75 mmol钙/L的血液透析期间，钙损失是适度的;（2）在透析前血浆钙浓度不低的情况下，用含0.75 mmol钙/L的透析液进行单次4小时治疗是安全的;和（3）在临床相关范围内的透析液钙浓度的变化不影响通过血液透析的磷去除。我们警告不要将我们在这些急性研究中的结果外推到使用低钙透析液的慢性治疗中，如果肠道钙吸收无法取代透析损失，则可能加重继发性甲状旁腺功能亢进。
We evaluated the acute effects of varying dialysate calcium concentration on plasma concentrations and dialyzer fluxes of calcium and phosphorus in adult hemodialysis patients. Seven individuals with stable end-stage renal failure were dialyzed 4 hours, three times weekly. The effects of dialysates containing 1.75, 1.25, or 0.75 mmol/L (70.1, 50.1, or 30.1 mg/L) of calcium were compared. Each patient was studied once at each bath calcium concentration. Compared with the predialysis mean value of 2.27 mmol/L (9.1 mg/dL), plasma total calcium concentration increased, remained constant, or decreased with the 1.75-,1.25-, or 0.75-mmol/L calcium dialysates, respectively. The 0.75-mmol/L calcium dialysate did not cause signs or symptoms of hypocalcemia (and the plasma calcium concentration did not fall below 1.80 mmol/L [7.2 mg/dL). Plasma phosphorus concentrations decreased equally from a predialysis mean value of 2.16 mmol/L (6.7 mg/dL), regardless of the dialysate calcium concentration. After 4 hours of treatment with the three different dialysates, the cumulative calcium fluxes were significantly different. With 1.75 mmol/L calcium, mean bodily calcium accumulation was 21.9 mmol (879 mg). With 1.25 mmol/L, there was no net calcium flux. With 0.75 mmol/L, mean patient calcium loss was 5.8 mmol (231 mg). Mean phosphorus removal after 4 hours was 32.5 mmol (1,006 mg) and was unaffected by dialysate calcium concentration. We conclude that (1) during hemodialysis with 1.75 mmol calcium/L, net calcium flux into the patients is substantial, whereas during hemodialysis with 0.75 mmol calcium/L, calcium losses are modest; (2) a single 4-hour treatment with a dialysate containing 0.75 mmol calcium/L is safe, provided that predialysis plasma calcium concentration is not low; and (3) variations in dialysate calcium concentration within the clinically relevant range do not affect phosphorus removal by hemodialysis. We caution against the extrapolation of our results in these acute studies to chronic treatment with low calcium dialysates, which could aggravate secondary hyperparathyroidism if intestinal calcium absorption fails to replace dialytic losses.