低钙透析在高钙血症危象治疗中的应用。

The Use of Low-Calcium Hemodialysis in the Treatment of Hypercalcemic Crisis.

机构信息

Department of Nephrology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.

Department of Nephrology, Kilis Public Hospital, Kilis, Turkey.

出版信息

Nephron. 2018;139(4):319-331. doi: 10.1159/000488502. Epub 2018 Apr 19.

DOI:10.1159/000488502

PMID:29672319

Abstract

BACKGROUND

We reviewed the results of low-calcium hemodialysis (LCHD; 1.25 mmol/L) in the treatment of 42 cases admitting with hypercalcemic crisis.

METHODS

All patients (≥18 years) who started LCHD due to hypercalcemia between 2002 and 2017 were retrospectively analyzed. Biochemical data were obtained at the beginning of the first hemodialysis and at the end of the last hemodialysis. -"Refractory" cases were defined as patients having albumin corrected serum total calcium (SCatotal) levels above 10.2 mg/dL despite of all medical, surgical, and hemodialysis treatments.

RESULTS

By acceptance of 3 cases admitted again over 6 months as new cases, a total of 42 cases (male, 57.1%) with a mean age of 55.9 ± 14.8 years underwent urgent hemodialysis. Most of the patients (82.1%) had malignancies. The mean SCatotal level at the beginning of hemodialysis sessions was 15.89 ± 2.53 mg/dL. The mean decline of SCatotal level was 4.63 ± 2.72 mg/dL. Refractory cases received hemodialysis after admission significantly later than improved cases (48 [interquartile ranges (IQR) 24-168] vs. 24 [IQR 12-48] h, p = 0.010). Serum creatinine and SCatotal levels at the last visit were significantly more in refractory cases than improved cases (1.92 [IQR 0.81-3.41] vs. 1.30 [IQR 0.8-1.7] mg/dL, p = 0.031 and 12.43 ± 2.53 vs. 8.86 ± 0.67 mg/dL, p = 0.000 respectively). Mortality was significantly higher in refractory cases than improved cases (58.8 vs. 10.5%, p = 0.002). Overall mortality rate was 33.3%.

CONCLUSION

Hypercalcemic crisis is a life-threatening condition and should be managed immediately.

摘要

背景

我们回顾了低钙血液透析（LCHD；1.25mmol/L）在 42 例高钙血症危象患者治疗中的结果。

方法

回顾性分析 2002 年至 2017 年间因高钙血症开始 LCHD 的所有（≥18 岁）患者。在第一次血液透析开始时和最后一次血液透析结束时获得生化数据。-“难治性”病例定义为尽管接受了所有药物、手术和血液透析治疗，但白蛋白校正血清总钙（SCatotal）水平仍高于 10.2mg/dL 的患者。

结果

接受 3 例 6 个月以上再次入院的新病例，共 42 例（男，57.1%），平均年龄 55.9±14.8 岁，行紧急血液透析。大多数患者（82.1%）患有恶性肿瘤。血液透析开始时的平均 SCatotal 水平为 15.89±2.53mg/dL。SCatotal 水平的平均下降为 4.63±2.72mg/dL。难治性病例的血液透析入院时间明显晚于改善病例（48[四分位间距（IQR）24-168]vs.24[IQR 12-48]h，p=0.010）。难治性病例最后一次就诊时的血清肌酐和 SCatotal 水平明显高于改善病例（1.92[IQR 0.81-3.41]vs.1.30[IQR 0.8-1.7]mg/dL，p=0.031 和 12.43±2.53vs.8.86±0.67mg/dL，p=0.000）。难治性病例的死亡率明显高于改善病例（58.8%vs.10.5%，p=0.002）。总体死亡率为 33.3%。