Cho Min Seok, Lee Kyun Sang, Lee Youn Kyoung, Ma Seong Kwon, Ko Jeong Hee, Kim Soo Wan, Kim Nam Ho, Choi Ki Chul
Department of Internal Medicine, Chonnam National University Medical School, Kwangju, Korea.
Korean J Intern Med. 2002 Jun;17(2):114-21. doi: 10.3904/kjim.2002.17.2.114.
Patients on continuous ambulatory peritoneal dialysis (CAPD) have increased risk of low-turnover bone disease and relative hypoparathyroidism. Recently, it has been believed that magnesium plays an important role in regulating secretion of parathyroid hormone (PTH). The aim of this study was to evaluate the relationship between serum PTH and serum magnesium as a factor increasing the frequency of relative hypoparathyroidism.
We analyzed the data of 56 patients who had been on CAPD for more than 6 months without any significant problems. No patient had been previously treated with vitamin D or aluminum hydroxide. The patients had used peritoneal dialysate with the magnesium concentration of 0.5 mEq/L. Biochemical parameters, such as BUN, creatinine, alkaline phosphatase bony isoenzyme, total protein, albumin, total calcium, ionized calcium and intact parathyroid hormone level were measured.
The mean serum magnesium level was 1.99 +/- 0.36 mEq/L. Among total 56 patients, 15 patients (26.8%) showed hypermagnesemia (serum magnesium > 2.2 mEq/L) and 5 patients (8.9%) showed hypomagnesemia (serum magnesium < 1.6 mEq/L). Among all 56 patients, serum iPTH (intact PTH) level was not correlated with serum magnesium level. However, it was inversely correlated with serum total calcium and ionized calcium levels, respectively (r = -0.365, p = 0.006; r = -0.515 p < 0.001). Among 49 patients whose serum iPTH level was less than 300 pg/mL, serum iPTH level was inversely correlated with serum magnesium level (r = -0.295, p = 0.039) and inversely correlated with serum total calcium and ionized calcium levels, respectively (r = -0.546, p < 0.001; r = -0.572 p < 0.001). Among 49 patients whose serum iPTH level was less than 300 pg/mL, lower iPTH group (serum iPTH < 120 pg/mL) showed higher serum magnesium level (p = 0.037), higher serum total calcium level (p < 0.001) and lower bone isoenzyme of alkaline phosphatase level (p < 0.001) than those of higher iPTH group (120 pg/mL < or = serum iPTH < 300 pg/mL).
Among the CAPD patients whose serum iPTH level was less than 300 pg/mL, there was a significant inverse correlation between serum iPTH level and serum magnesium level. This study indicates that not only serum calcium level but also serum magnesium level are important in the regulation of serum iPTH levels of CAPD patients who have been dialyzed by low-magnesium peritoneal dialysate.
持续非卧床腹膜透析（CAPD）患者发生低转换骨病和相对性甲状旁腺功能减退的风险增加。最近，人们认为镁在调节甲状旁腺激素（PTH）分泌中起重要作用。本研究的目的是评估血清PTH与血清镁之间的关系，血清镁是增加相对性甲状旁腺功能减退发生率的一个因素。
我们分析了56例接受CAPD超过6个月且无任何重大问题的患者的数据。此前没有患者接受过维生素D或氢氧化铝治疗。患者使用的腹膜透析液镁浓度为0.5 mEq/L。测量了生化参数，如尿素氮、肌酐、碱性磷酸酶骨同工酶、总蛋白、白蛋白、总钙、离子钙和完整甲状旁腺激素水平。
血清镁平均水平为1.99±0.36 mEq/L。在56例患者中，15例（26.8%）出现高镁血症（血清镁>2.2 mEq/L），5例（8.9%）出现低镁血症（血清镁<1.6 mEq/L）。在所有56例患者中，血清iPTH（完整PTH）水平与血清镁水平无相关性。然而，它分别与血清总钙和离子钙水平呈负相关（r = -0.365，p = 0.006；r = -0.515，p < 0.001）。在49例血清iPTH水平低于300 pg/mL的患者中，血清iPTH水平与血清镁水平呈负相关（r = -0.295，p = 0.039），分别与血清总钙和离子钙水平呈负相关（r = -0.546，p < 0.001；r = -0.572，p < 0.001）。在49例血清iPTH水平低于300 pg/mL的患者中，iPTH较低组（血清iPTH<120 pg/mL）的血清镁水平较高（p = 0.037），血清总钙水平较高（p < 0.001），碱性磷酸酶骨同工酶水平较低（p < 0.001），高于iPTH较高组（120 pg/mL≤血清iPTH<300 pg/mL）。
在血清iPTH水平低于300 pg/mL的CAPD患者中，血清iPTH水平与血清镁水平之间存在显著负相关。本研究表明，对于使用低镁腹膜透析液进行透析的CAPD患者，不仅血清钙水平，血清镁水平在调节血清iPTH水平方面也很重要。
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