Cao Xue-Ying, Zhou Jian-Hui, Cai Guang-Yan, Ding Rui, Tang Li, Wu Di, Wei Ri-Bao, Chen Xiang-Mei
Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases Beijing 100853, China.
Int J Clin Exp Med. 2015 Feb 15;8(2):2031-7. eCollection 2015.
Low calcium dialysate with 1.25 mmol/l calcium concentration has been proposed to replace standard calcium dialysate in peritoneal dialysis patients taking calcium-containing phosphate binder to prevent hypercalcaemia. We conducted a meta-analysis to evaluate long term effects on mineral and bone metabolism by low versus standard calcium dialysate in peritoneal dialysis.
Clinical studies comparing low versus standard calcium dialysate in peritoneal dialysis patients were identified by searching PubMed (from 1990 to October 2013) and EMBASE (from 1990 to October 2013). Major outcomes extracted for meta-analysis were: serum total and ionized calcium, phosphate, parathyroid hormone and bone metabolism. Statistical analyses were performed using the Review Manager, version 5.1.0 (Cochrane Collaboration, Oxford, UK).
Four studies were identified for meta-analysis. A total of 240 peritoneal dialysis patients received standard calcium dialysate and 106 patients were given low calcium dialysate. 1-2 year after peritoneal dialysis, both serum total and ionized calcium were lower in low calcium dialysate patients as compared with standard dialysate patients (Total calcium: MD, 0.09; 95% CI, 0.05 0.13; P < 0.0001; Ionized calcium: MD, 0.04; 95% CI, 0.02 0.06; P < 0.0001). No statistical difference was observed in phosphate level between two groups (MD, -0.05; 95% CI, -0.13 0.02; P = 0.19). Intact parathyroid hormone level was significantly increased in low calcium dialysate patients. No clinically significant long term change of bone metabolism was observed between low and standard calcium dialysate treated patients.
Long term (1-2 year) use of low calcium dialysate with 1.25 mmol/l calcium concentration in peritoneal dialysis patients results in decrease of serum total and ionized calcium level and does not change serum phosphate level. No clinical significance in the change of bone metabolism was observed between low and standard calcium dialysate patients despite the increase of serum parathyroid hormone in low calcium dialysate group.
对于正在服用含钙磷结合剂的腹膜透析患者，有人提议使用钙浓度为1.25 mmol/l的低钙透析液替代标准钙透析液，以预防高钙血症。我们进行了一项荟萃分析，以评估腹膜透析中低钙透析液与标准钙透析液对矿物质和骨代谢的长期影响。
通过检索PubMed（1990年至2013年10月）和EMBASE（1990年至2013年10月），确定了比较腹膜透析患者低钙透析液与标准钙透析液的临床研究。提取用于荟萃分析的主要结果为：血清总钙和离子钙、磷、甲状旁腺激素和骨代谢。使用Review Manager 5.1.0版（英国牛津Cochrane协作网）进行统计分析。
确定了四项研究用于荟萃分析。共有240例腹膜透析患者接受标准钙透析液，106例患者接受低钙透析液。腹膜透析1至2年后，与标准透析液组患者相比，低钙透析液组患者的血清总钙和离子钙均较低（总钙：MD，0.09；95%CI，0.05至0.13；P<0.0001；离子钙：MD，0.04；95%CI，0.02至0.06；P<0.0001）。两组之间的磷水平未观察到统计学差异（MD，-0.05；95%CI，-0.13至0.02；P = 0.19）。低钙透析液组患者的完整甲状旁腺激素水平显著升高。在接受低钙透析液和标准钙透析液治疗的患者之间，未观察到具有临床意义的骨代谢长期变化。
在腹膜透析患者中长期（1至2年）使用钙浓度为1.25 mmol/l的低钙透析液会导致血清总钙和离子钙水平降低，且不会改变血清磷水平。尽管低钙透析液组患者的血清甲状旁腺激素升高，但在低钙透析液和标准钙透析液患者之间，未观察到骨代谢变化具有临床意义。
