Yavuz A, Ersoy F F, Passadakis P S, Tam P, Evaggelos D M, Katopodis K P, Ozener C, Akçiçek F, Camsari T, Ateş K, Ataman R, Vlachojannis G J, Dombros N A, Utaş C, Akpolat T, Bozfakioğlu S, Wu G, Karayaylali I, Arinsoy T, Stathakis C P, Yavuz M, Tsakiris D J, Dimitriades A C, Yilmaz M E, Gültekin M, Süleymanlar G, Oreopoulos D G
Akdeniz University, Antalya, Turkey.
Kidney Int Suppl. 2008 Apr(108):S152-8. doi: 10.1038/sj.ki.5002617.
Hyperphosphatemia is independently associated with an increased risk of death among dialysis patients. In this study, we have assessed the status of phosphate control and its clinical and laboratory associations in a large international group of patients on chronic peritoneal dialysis (PD) treatment. This cross-sectional multicenter study was carried out in 24 centers in three different countries (Canada, Greece, and Turkey) among 530 PD patients (235 women, 295 men) with a mean+/-s.d. age of 55+/-16 years and mean duration of PD of 33+/-25 months. Serum calcium (Ca(2+)), ionized Ca(2+), phosphate, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D(3), 1,25-dihydroxy vitamin D(3), total alkaline phosphatase, and bone alkaline phosphatase concentrations were investigated, along with adequacy parameters such as Kt/V, weekly creatinine clearance, and daily urine output. Mean Kt/V was 2.3+/-0.65, weekly creatinine clearance 78.5+/-76.6 l, and daily urine output 550+/-603 ml day(-1). Fifty-five percent of patients had a urine volume of <400 ml day(-1). Mean serum phosphorus level was 4.9+/-1.3 mg per 100 ml, serum Ca(2+) 9.4+/-1.07 mg per 100 ml, iPTH 267+/-356 pg ml(-1), ionized Ca(2+) 1.08+/-0.32 mg per 100 ml, calcium phosphorus (Ca x P) product 39+/-19 mg(2)dl(-2), 25(OH)D(3) 8.3+/-9.3 ng ml(-1), 1,25(OH)(2)D(3) 9.7+/-6.7 pg ml(-1), total alkaline phosphatase 170+/-178 U l(-1), and bone alkaline phosphatase 71+/-108 U l(-1). While 14% of patients were hypophosphatemic, with a serum phosphorus level lower than 3.5 mg per 100 ml, most patients (307 patients, 58%) had a serum phosphate level between 3.5 and 5.5 mg per 100 ml. Serum phosphorus level was 5.5 mg per 100 ml or greater in 28% (149) of patients. Serum Ca(2+) level was > or =9.5 mg per 100 ml in 250 patients (49%), between 8.5 and 9.5 mg per 100 ml in 214 patients (40%), and lower than 8.5 mg per 100 ml in 66 patients (12%). Ca x P product was >55 mg(2)dl(-2) in 136 patients (26%) and lower than 55 mg(2)dl(-2) in 394 patients (74%). Serum phosphorus levels were positively correlated with serum albumin (P<0.027) and iPTH (P=0.001), and negatively correlated with age (P<0.033). Serum phosphorus was also statistically different (P = 0.013) in the older age group (>65 years) compared to younger patients; mean levels were 5.1+/-1.4 and 4.5+/-1.1 mg per 100 ml, respectively, in the two groups. In our study, among 530 PD patients, accepted uremic-normal limits of serum phosphorus control was achieved in 58%, Ca x P in 73%, serum Ca(2+) in 53%, and iPTH levels in 24% of subjects. Our results show that chronic PD, when combined with dietary measures and use of phosphate binders, is associated with satisfactory serum phosphorus control in the majority of patients.
高磷血症与透析患者死亡风险增加独立相关。在本研究中，我们评估了一大组接受慢性腹膜透析（PD）治疗的国际患者的磷酸盐控制状况及其临床和实验室相关性。这项横断面多中心研究在三个不同国家（加拿大、希腊和土耳其）的24个中心开展，研究对象为530例PD患者（235例女性，295例男性），平均年龄55±16岁，PD平均疗程33±25个月。检测了血清钙（Ca(2+)）、离子钙（Ca(2+)）、磷酸盐、完整甲状旁腺激素（iPTH）、25-羟维生素D(3)、1,25-二羟维生素D(3)、总碱性磷酸酶和骨碱性磷酸酶浓度，以及诸如Kt/V、每周肌酐清除率和每日尿量等充分性参数。平均Kt/V为2.3±0.65，每周肌酐清除率78.5±76.6 l，每日尿量550±603 ml·day(-1)。55%的患者尿量<400 ml·day(-1)。平均血清磷水平为4.9±1.3 mg/100 ml，血清Ca(2+) 9.4±1.07 mg/100 ml，iPTH 267±356 pg·ml(-1)，离子钙（Ca(2+)）1.08±0.32 mg/100 ml，钙磷（Ca×P）乘积3（9±19 mg(2)·dl(-2)），25(OH)D(3) 8.3±9.3 ng·ml(-1)，1,25(OH)(2)D(3) 9.7±6.7 pg·ml(-1)，总碱性磷酸酶170±178 U·ml(-1)，骨碱性磷酸酶71±108 U·ml(-1)。虽然14%的患者为低磷血症，血清磷水平低于3.5 mg/100 ml，但大多数患者（30例患者，58%）的血清磷酸盐水平在3.5至5.5 mg/100 ml之间。28%（149例）患者的血清磷水平为5.5 mg/100 ml或更高。250例患者（49%）的血清Ca(2+)水平≥9.5 mg/100 ml，214例患者（40%）的血清Ca(2+)水平在8.5至9.5 mg/100 ml之间，66例患者（12%）的血清Ca(2+)水平低于8.5 mg/100 ml。136例患者（26%）的Ca×P乘积>55 mg(2)·dl(-2)，而394例患者（74%）的Ca×P乘积低于55 mg(2)·dl(-2)。血清磷水平与血清白蛋白呈正相关（P<0.027），与iPTH呈正相关（P=0.001），与年龄呈负相关（P<0.033）。与年轻患者相比，老年组（>65岁）的血清磷水平也有统计学差异（P = 0.013）；两组的平均水平分别为5.1±1.4和4.5±1.1 mg/·100 ml。在我们的研究中，530例PD患者中，58%的患者达到了血清磷控制的公认尿毒症正常范围，73%的患者达到了Ca×P正常范围，53%的患者达到了血清Ca(2+)正常范围，24%的患者达到了iPTH水平正常范围。我们的结果表明，慢性PD与饮食措施和使用磷结合剂相结合，在大多数患者中与令人满意的血清磷控制相关。
Perit Dial Int. 2016
Int J Nephrol Renovasc Dis. 2014-7-5
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