Reversal of adynamic bone disease by lowering of dialysate calcium
Reversal of adynamic bone disease by lowering of dialysate calcium
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DOI：
10.1038/sj.ki.5001666
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发表时间：
2006-09-01
影响因子：
19.6
通讯作者：
Hercz, G.
中科院分区：
文献类型：
--
作者：
Haris, A.;Sherrard, D. J.;Hercz, G.
越来越多的人认识到，尤其是在接受口服碳酸钙、维生素D补充剂或超生理透析液钙治疗的透析患者中，存在粘连性骨病（ABD）。我们进行了这项研究，以评估降低透析液钙对高钙血症发作，血清甲状旁腺激素（PTH）水平以及骨转换的影响。51例接受腹膜透析和活检证实的ABD治疗的患者随机接受16个月的对照钙（1.62 mM）或低钙（1.0 mM）透析液钙治疗。在低透析液钙组中，14名患者完成了研究。这一组的血清总钙和离子钙水平降低，高钙血症发作减少89%，导致血清PTH值增加300%，从6.0 +/-1.6 μ M增加到24.9 +/-3.6 μ M（P <0.0001）。骨形成率，最初都受到抑制，从18.1 +/-5.6 μ m（2）/mm（2）/天上升到159 +/-59.4 μ m（2）/mm（2）/天（P <0.05），进入正常范围（> 108 μ m（2）/mm（2）/天）。在对照组中，9名患者完成了研究。他们的甲状旁腺素水平没有显著增加，从7.3 +/-1.6到9.4 +/-1.5 μ M，骨形成率也没有显著变化，从13.3 +/-7.1到40.9 +/-11.9 μ m（2）/mm（2）/天。降低腹膜透析液钙可降低血清钙水平和高钙血症发作，导致ABD患者PTH水平升高和骨转换正常化。
Adynamic bone disease (ABD) is increasingly recognized, especially in dialysis patients treated with oral calcium carbonate, vitamin D supplements, or supraphysiological dialysate calcium. We undertook this study to assess the effect of lowering dialysate calcium on episodes of hypercalcemia, serum parathyroid hormone (PTH) levels as well as bone turnover. Fifty-one patients treated with peritoneal dialysis and biopsy-proven ABD were randomized to treatment with control calcium, 1.62mM, or low calcium, 1.0mM, dialysate calcium over a 16-month period. In the low dialysate calcium group, 14 patients completed the study. This group experienced a decrease in serum total and ionized calcium levels, and an 89% reduction in episodes of hypercalcemia, resulting in a 300% increase in serum PTH values, from 6.0 +/- 1.6 to 24.9 +/- 3.6 mu M (P < 0.0001). Bone formation rates, all initially suppressed, at 18.1 +/- 5.6 mu m(2)/mm(2)/day rose to 159 +/- 59.4 mu m(2)/mm(2)/day (P < 0.05), into the normal range (> 108 mu m(2)/mm(2)/day). In the control group, nine patients completed the study. Their PTH levels did not increase significantly, from 7.3 +/- 1.6 to 9.4 +/- 1.5 mu M and bone formation rates did not change significantly either, from 13.3 +/- 7.1 to 40.9 +/- 11.9 mu m(2)/mm(2)/day. Lowering of peritoneal dialysate calcium reduced serum calcium levels and hypercalcemic episodes, which resulted in increased PTH levels and normalization of bone turnover in patients with ABD.