Krachler M, Scharfetter H, Wirnsberger G H
Institute of Analytical Chemistry, Medical School, Karl Franzens University, Graz, Austria.
Nephron. 1999;83(3):226-36. doi: 10.1159/000045515.
In the past, nephrologists have been troubled by electrolyte disturbances and consequently focused their attention on the importance of maintaining the concentrations of electrolytes within the normal range. However, information about the potential role of trace elements in chronic renal failure is scarce.
During hemodialysis sessions, the concentrations of the five alkali metal cations lithium (Li), sodium (Na), potassium (K), rubidium (Rb), and cesium (Cs) have been determined in plasma and dialysis fluids of chronic hemodialysis patients by inductively coupled plasma mass spectrometry (Li, Rb, Cs) and by ion-sensitive electrodes (Na, K). Strict quality control schemes were applied to all analytical procedures to ensure accuracy and precision of the results.
The plasma concentrations of the elements Li, Cs, Rb, and K distinctly decreased to 29, 50, 69, and 71%, respectively, of their initial values during hemodialysis. Simultaneously, the concentrations of these elements in dialysis fluids at the outlet of the dialyzer increased approximately 13-fold for Rb, 11-fold for Li, 3-fold for Cs, and 2-fold for K as compared with the inlet values. The concentrations of Na in plasma and dialysis fluids were almost identical and did not change during hemodialysis.
Li, Rb, and Cs were depleted in hemodialysis patients, although the plasma concentrations of these trace elements still remained within the reference ranges for healthy adults. Consequently, further studies are needed to elucidate the clinical importance and long-term effects of these trace element imbalances - for example, CNS disturbances associated with diminished concentrations of Rb - in hemodialysis patients.
过去，肾病学家一直受电解质紊乱困扰，因此将注意力集中在维持电解质浓度在正常范围内的重要性上。然而，关于微量元素在慢性肾衰竭中潜在作用的信息却很匮乏。
在血液透析过程中，通过电感耦合等离子体质谱法（用于锂、铷、铯）和离子敏感电极（用于钠、钾）测定慢性血液透析患者血浆和透析液中五种碱金属阳离子锂（Li）、钠（Na）、钾（K）、铷（Rb）和铯（Cs）的浓度。对所有分析程序都应用了严格的质量控制方案，以确保结果的准确性和精密度。
在血液透析期间，锂、铯、铷和钾元素的血浆浓度分别明显降至其初始值的29%、50%、69%和71%。同时，与入口值相比，透析器出口处透析液中这些元素的浓度，铷增加了约13倍，锂增加了11倍，铯增加了3倍，钾增加了2倍。血浆和透析液中钠的浓度几乎相同，且在血液透析过程中没有变化。
血液透析患者体内锂、铷和铯出现耗竭，尽管这些微量元素的血浆浓度仍处于健康成年人的参考范围内。因此，需要进一步研究以阐明这些微量元素失衡在血液透析患者中的临床重要性和长期影响——例如，与铷浓度降低相关的中枢神经系统紊乱。
