Niwa Hiroki, Fukasawa Hirotaka, Ishibuchi Kento, Kaneko Mai, Yasuda Hideo, Furuya Ryuichi
Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Japan.
First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Ther Apher Dial. 2018 Oct;22(5):503-508. doi: 10.1111/1744-9987.12673. Epub 2018 Jun 20.
Although the Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend a dialysate calcium concentration between 2.5 and 3.0 mEq/L, its optimal concentration remains unclear. A total of 53 hemodialysis patients with intact parathyroid hormone (PTH) levels <150 pg/mL were enrolled in this prospective observational study. A dialysate calcium concentration was converted from 3.0 to 2.75 mEq/L and bone metabolic markers including bone alkaline phosphatase (BAP) and tartrate-resistant acid phosphatase-5b (TRACP-5b) were examined. After 3 months, serum corrected calcium levels decreased (P < 0.001), while serum intact PTH, BAP and TRACP-5b levels increased (P < 0.05, P < 0.05 and P < 0.001, respectively). Multiple regression analyses showed that the amount of change in BAP was significantly associated with dialysis vintage (P < 0.01). In conclusion, the lowering of dialysate calcium concentration stimulated parathyroid gland and bone remodeling in hemodialysis patients with suppressed PTH, particularly with longer dialysis vintage.
尽管改善全球肾脏病预后组织（KDIGO）指南推荐透析液钙浓度在2.5至3.0 mEq/L之间，但其最佳浓度仍不明确。本前瞻性观察性研究共纳入了53例甲状旁腺激素（PTH）水平<150 pg/mL的血液透析患者。将透析液钙浓度从3.0 mEq/L转换为2.75 mEq/L，并检测骨代谢标志物，包括骨碱性磷酸酶（BAP）和抗酒石酸酸性磷酸酶-5b（TRACP-5b）。3个月后，血清校正钙水平下降（P<0.001），而血清完整PTH、BAP和TRACP-5b水平升高（分别为P<0.05、P<0.05和P<0.001）。多元回归分析显示，BAP的变化量与透析龄显著相关（P<0.01）。总之，在PTH受抑制的血液透析患者中，尤其是透析龄较长者，降低透析液钙浓度会刺激甲状旁腺和骨重塑。
