Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2011 Sep;26(3):320-7. doi: 10.3904/kjim.2011.26.3.320. Epub 2011 Sep 13.
BACKGROUND/AIMS: We assessed changes in hemodynamic and arterial stiffness parameters following reductions of dialysate calcium concentrations in patients undergoing hemodialysis.
In this prospective study, 20 patients on maintenance hemodialysis (10 females, 10 males) with dialysate calcium concentrations of 1.75 mmol/L were enrolled. At the start of the study, the dialysate calcium level was lowered to 1.50 mmol/L. Serial changes in biochemical, hemodynamic, and arterial stiffness parameters, including pulse wave velocity (PWV) and augmentation index (AIx), were assessed every 2 months for 6 months. We also examined changes in the calcification-inhibitory protein, serum fetuin-A.
During the 6-month study period, serum total calcium and ionized calcium decreased consistently (9.5 ± 1.0 to 9.0 ± 0.7, p = 0.002 vs. 1.3 ± 0.1 to 1.1 ± 0.1, p = 0.035). Although no apparent changes in blood pressure were observed, heart-femoral PWW (hf-PWV) and AIx showed significant improvement (p = 0.012, 0.043, respectively). Repeated-measures ANOVA indicated a significant effect of lowering dialysate calcium on hf-PWV (F = 4.58, p = 0.004) and AIx (F = 2.55, p = 0.049). Accompanying the change in serum calcium, serum fetuin-A levels significantly increased (95.8 ± 45.8 pmol/mL at baseline to 124.9 ± 82.2 pmol/mL at 6 months, p = 0.043).
Lowering dialysate calcium concentration significantly improved arterial stiffness parameters, which may have been associated with upregulation of serum fetuin-A.
背景/目的：我们评估了在接受血液透析的患者中降低透析液钙浓度后血流动力学和动脉僵硬参数的变化。
在这项前瞻性研究中，我们纳入了 20 名接受 1.75mmol/L 透析液钙浓度的维持性血液透析患者（10 名女性，10 名男性）。在研究开始时，将透析液钙水平降低至 1.50mmol/L。每 2 个月评估一次生化、血流动力学和动脉僵硬参数（包括脉搏波速度[PWV]和增强指数[AIx]）的变化，共 6 个月。我们还检查了抑制钙化蛋白、血清胎球蛋白-A 的变化。
在 6 个月的研究期间，血清总钙和离子钙持续下降（9.5±1.0 至 9.0±0.7，p=0.002 与 1.3±0.1 至 1.1±0.1，p=0.035）。尽管血压无明显变化，但心-股 PWV（hf-PWV）和 AIx 显著改善（p=0.012，0.043）。重复测量方差分析表明，降低透析液钙对 hf-PWV（F=4.58，p=0.004）和 AIx（F=2.55，p=0.049）有显著影响。随着血清钙的变化，血清胎球蛋白-A 水平显著升高（基线时为 95.8±45.8pmol/mL，6 个月时为 124.9±82.2pmol/mL，p=0.043）。
降低透析液钙浓度显著改善了动脉僵硬参数，这可能与血清胎球蛋白-A 的上调有关。
