Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada.
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Am J Kidney Dis. 2015 Aug;66(2):348-58. doi: 10.1053/j.ajkd.2015.02.336. Epub 2015 May 7.
Patients with end-stage kidney disease treated with dialysis are at increased risk to experience fractures and cardiovascular events than similar-aged people from the general population. The enhanced risk for these outcomes in dialysis patients is not completely explained by traditional risk factors for osteoporosis and cardiovascular disease. Mineral metabolism abnormalities are almost universal by the time patients require dialysis therapy, with most patients having some type of renal osteodystrophy and vascular calcification. These abnormalities have been linked to adverse skeletal and cardiovascular events. However, it has become clear that the treatment regimens used to modify the serum calcium, phosphate, and parathyroid hormone levels almost certainly contribute to the poor outcomes for dialysis patients. In this article, we focus on one aspect of mineral metabolism management; dialysate calcium concentration and the relationships among dialysate calcium concentrations, mineral and bone disorder, and cardiovascular disease in hemodialysis patients.
接受透析治疗的终末期肾病患者比一般人群中同龄患者更容易发生骨折和心血管事件。透析患者发生这些结果的风险增加不能完全用骨质疏松症和心血管疾病的传统危险因素来解释。当患者需要透析治疗时，矿物质代谢异常几乎是普遍存在的，大多数患者都有某种类型的肾性骨营养不良和血管钙化。这些异常与不良的骨骼和心血管事件有关。然而，很明显，用于改变血清钙、磷和甲状旁腺激素水平的治疗方案肯定会导致透析患者的预后不良。在本文中，我们重点关注矿物质代谢管理的一个方面；透析液钙浓度以及透析液钙浓度、矿物质和骨代谢紊乱以及血液透析患者心血管疾病之间的关系。
