UCL Center for Nephrology, Royal Free Campus, University College London Medical School, London, UK.
Blood Purif. 2010;30(2):111-7. doi: 10.1159/000319954. Epub 2010 Aug 12.
Patients achieving the Kidney Disease Outcomes Quality Initiative (KDOQI) bone mineral clinical practice guidelines have been reported to have improved survival. Many factors affecting calcium and phosphate control are not modifiable; however, we wished to determine whether differences in dialysis treatment could affect achievement of KDOQI clinical guideline targets.
We audited pre-mid-week session calcium and phosphate levels in 5,324 adult patients receiving thrice weekly dialysis in the 14 Pan Thames centres: 60% male, mean age 62 ± 16 years, median dialysis vintage 29 months (14-58), 84% treated by haemodialysis, 16% by online haemodiafiltration, median session time 4.0 h (3.5-4.0).
Patients achieving the KDOQI guidelines varied between the centres: 23.4-60% for calcium, 31.7-56.7% for phosphate, 60-87.3% for calcium-phosphate product, 17.1-46.8% for parathyroid hormone (PTH) and 1.8-10.8% for all 4 targets. Those centres which used the highest dialysate calcium concentrations (1.5 mmol/l, 3 mEq/l) had more patients above the KDOQI serum calcium and more below the PTH target, than those centres using the lowest calcium dialysates (1 mmol/l, 2 mEq/l), with χ(2) = 85.1 and χ(2) = 52.4, p < 0.001, respectively. On logistic regression analysis, serum phosphate was negatively associated with duration of dialysis session time (F = 21.4, p = 0.000) and haemodiafiltration (F = 9.6, p = 0.000), respectively.
Although many of the factors determining calcium and phosphate control in haemodialysis patients are unmodifiable, dialysate calcium concentration, the duration of the dialysis session and haemodiafiltration all had an impact on calcium, phosphate and PTH.
据报道，达到肾脏病预后质量倡议（KDOQI）骨矿物质临床实践指南的患者的生存率有所提高。许多影响钙和磷酸盐控制的因素是不可改变的；然而，我们希望确定透析治疗的差异是否会影响 KDOQI 临床指南目标的实现。
我们对在 14 个泰晤士河沿岸中心接受每周三次透析的 5324 名成年患者的预周中钙和磷酸盐水平进行了审核：60%为男性，平均年龄 62±16 岁，中位透析龄 29 个月（14-58），84%接受血液透析治疗，16%接受在线血液透析滤过治疗，中位治疗时间 4.0 小时（3.5-4.0）。
各中心达到 KDOQI 指南的患者比例不同：钙为 23.4-60%，磷酸盐为 31.7-56.7%，钙-磷酸盐乘积为 60-87.3%，甲状旁腺激素（PTH）为 17.1-46.8%，所有 4 个目标均为 1.8-10.8%。那些使用最高透析液钙浓度（1.5mmol/l，3mEq/l）的中心，血钙超过 KDOQI 血清钙的患者和 PTH 目标值以下的患者比例高于使用最低钙透析液的中心（1mmol/l，2mEq/l），χ(2)分别为 85.1 和 52.4，p<0.001。Logistic 回归分析显示，血清磷酸盐与透析治疗时间（F=21.4，p=0.000）和血液透析滤过（F=9.6，p=0.000）呈负相关。
尽管许多决定血液透析患者钙和磷酸盐控制的因素是不可改变的，但透析液钙浓度、透析治疗时间和血液透析滤过对钙、磷酸盐和 PTH 都有影响。
