Calcium and phosphate balance with quotidian hemodialysis.
Calcium and phosphate balance with quotidian hemodialysis.
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DOI：
10.1016/s0272-6386(03)00534-1
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发表时间：
2003-07-01
期刊：
影响因子：
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通讯作者：
Kortas, Claude
中科院分区：
文献类型：
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作者：
Lindsay, Robert M;Alhejaili, Fayez;Kortas, Claude
背景技术背景：常规血液透析（HD）与钙和磷代谢严重紊乱以及甲状旁腺激素（PTH）水平异常相关。更频繁的HD对钙磷平衡的影响尚未完全阐明。方法：伦敦每日/夜间血液透析研究检查了每日HD（n = 11）或夜间HD（n = 12）对钙磷代谢、骨碱性磷酸酶水平和完整PTH（iPTH）水平的影响。结果：每日HD患者显示透析前血清磷酸盐水平略有下降，磷酸盐结合剂需求或血清钙水平无变化，血清骨碱性磷酸酶和iPTH水平略有升高。夜间HD患者表现出透析前磷酸盐水平降低的趋势，多次显著低于每日HD和接受常规HD治疗的匹配对照患者。夜间HD患者的磷结合剂使用显著减少。在18个月时，两个埃塞俄比亚HD组均显示钙磷乘积降低，夜间HD患者的值（38.11 mg（2）/dL（2））显著低于每日HD和对照患者（分别为53.99和52.51 mg（2）/dL（2））。骨碱性磷酸酶水平略有增加，并达到统计学意义相比，基线值为两个埃塞俄比亚HD组。夜间HD患者血清iPTH水平升高的趋势，加上骨碱性磷酸酶水平升高，导致决定将透析液钙浓度从5.0 mg/dL增加至7.0 mg/dL。这1次调整导致趋势逆转，并返回到基线values.CONCLUSION：本研究显示，夜间HD患者的血清磷酸盐水平的上级控制相比，每日HD或常规HD患者和透析液的好处，在缓慢的夜间HD具有更高的钙浓度。
BACKGROUND: Conventional hemodialysis (HD) is associated with profound disturbances in calcium and phosphate metabolism and abnormal parathyroid hormone (PTH) levels. Effects of more frequent HD on calcium and phosphate balance have not been fully elucidated.METHODS: The London Daily/Nocturnal Hemodialysis Study examined effects of quotidian HD, either daily HD (n = 11) or nocturnal HD (n = 12), on calcium and phosphate metabolism, bone alkaline phosphatase levels, and intact PTH (iPTH) levels.RESULTS: Daily HD patients showed a slight decrease in predialysis serum phosphate levels, no changes in phosphate-binder requirements or serum calcium levels, and slight increases in serum bone alkaline phosphatase and iPTH levels. Nocturnal HD patients showed a trend for decreased predialysis phosphate levels, with significantly lower values than daily HD and matched control patients on conventional HD therapy at several times. Phosphate-binder use by nocturnal HD patients was significantly reduced. Both quotidian HD groups showed decreases in calcium x phosphate product, with significantly lower values for nocturnal HD patients (38.11 mg(2)/dL(2)) compared with daily HD and control patients (53.99 and 52.51 mg(2)/dL(2), respectively) at 18 months. Bone alkaline phosphatase levels increased slightly and attained statistical significance compared with baseline values for both quotidian HD groups. A trend for increases in serum iPTH levels, coupled with increasing levels of bone alkaline phosphatase in nocturnal HD patients, led to the decision to increase the dialysate calcium concentration from 5.0 to 7.0 mg/dL. This 1-time adjustment resulted in a reversal of the trend and a return to baseline values.CONCLUSION: This study shows the superior control of serum phosphate levels in nocturnal HD patients compared with daily HD or conventional HD patients and the benefits of dialysate with a greater calcium concentration in slow nocturnal HD.