Ardalan Mohammadreza, Safaei Ali, Tolouian Audrey, Tolouian Ramin, Ebrahimzadeh Attari Vahideh, Jalili Mahsa
Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
The University of Texas at El Paso School of Nursing, El Paso Texas, USA.
Caspian J Intern Med. 2022 Summer;13(3):527-532. doi: 10.22088/cjim.13.3.527.
Beyond the adverse effects of hyperphosphatemia in patients with chronic kidney disease (CKD(, hypophosphatemia has also been proposed as a common challenge after dialysis. Therefore, the present study aimed to evaluate the serum phosphate level immediately after hemodialysis (HD) and its association with some clinical complications in CKD patients.
The present cross-sectional study was conducted on 54 eligible CKD patients undergoing regular hemodialysis. Blood samples were taken, prior to the start and immediately after the end of hemodialysis to determine the serum levels of urea, creatinine, sodium, potassium, phosphorus, PTH, blood sugar and albumin. Moreover, the clinical complications of patients including muscle cramps, nausea, vomiting, headache, confusion, weakness and inability to speak are assessed by a questionnaire, before and after HD.
As we expected, the mean of serum creatinine, urea and phosphate levels significantly decreased after dialysis. Post-dialysis hypophosphatemia was graded as mild (3.5 > P ≥ 2.5 mg/dl), moderate (2.5 > P ≥ 1 mg/dl), and severe (<1 mg/dl) based on serum phosphate levels. The frequency of mild and moderate hypophosphatemia was 39.2% and 45.1 %, respectively. None of the participants had severe hypophosphatemia and 13.7% had normal phosphate levels. There was a significant correlation between post-dialysis hypophosphatemia and incidence of nausea and confusion after adjusting for confounding factors.
To our knowledge, this is the first time that the possible association of some of the post-dialysis clinical complications with hypophosphatemia was investigated. Future large-scale studies are required to confirm the association of post-dialysis hypophosphatemia with clinical complications.
除了慢性肾脏病（CKD）患者高磷血症的不良影响外，低磷血症也被认为是透析后的一个常见挑战。因此，本研究旨在评估血液透析（HD）后即刻的血清磷水平及其与CKD患者一些临床并发症的关联。
本横断面研究对54例接受定期血液透析的合格CKD患者进行。在血液透析开始前和结束后即刻采集血样，以测定血清尿素、肌酐、钠、钾、磷、甲状旁腺激素、血糖和白蛋白水平。此外，通过问卷在HD前后评估患者的临床并发症，包括肌肉痉挛、恶心、呕吐、头痛、意识模糊、虚弱和失语。
正如我们所预期的，透析后血清肌酐、尿素和磷水平的平均值显著降低。根据血清磷水平，透析后低磷血症分为轻度（3.5＞P≥2.5mg/dl）、中度（2.5＞P≥1mg/dl）和重度（＜1mg/dl）。轻度和中度低磷血症的发生率分别为39.2%和45.1%。没有参与者出现重度低磷血症，13.7%的患者磷水平正常。在调整混杂因素后，透析后低磷血症与恶心和意识模糊的发生率之间存在显著相关性。
据我们所知，这是首次研究透析后一些临床并发症与低磷血症之间可能的关联。未来需要大规模研究来证实透析后低磷血症与临床并发症之间的关联。
