Martino Francesca K, di Vico Valentina, Basso Anna, Gobbi Laura, Stefanelli Lucia Federica, Cacciapuoti Martina, Bettin Elisabetta, Del Prete Dorella, Scaparrotta Giuseppe, Nalesso Federico, Calò Lorenzo A
Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy.
Life (Basel). 2024 Jul 31;14(8):964. doi: 10.3390/life14080964.
Managing mineral bone disease (MBD) could reduce cardiovascular risk and improve the survival of dialysis patients. Our study focuses on the impact of calcium bath exposure in dialysis patients by comparing peritoneal dialysis patients (PD, intervention group) and hemodialysis patients (HD, control group). We assessed various factors, including calcium, phosphorus, magnesium, PTH, vitamin D 25-OH, C-terminal telopeptide (CTX), and FGF-23 levels, as well as the calcium bath six hours before the blood sample and the length of daily calcium exposure. We enrolled 40 PD and 31 HD patients with a mean age of 68.7 ± 13.6 years. Our cohort had median PTH and FGF-23 levels of 194 ng/L (Interquartile range [IQR] 130-316) and 1296 pg/mL (IQR 396-2698), respectively. We identified the length of exposure to a 1.25 mmol/L calcium bath, phosphate levels, and CTX as independent predictors of PTH (OR 0.279, = 0.011; OR 0.277, = 0.012; OR 0.11, = 0.01, respectively). In contrast, independent predictors of FGF-23 were phosphate levels (OR 0.48, < 0.001) and serum calcium levels (OR 0.25, = 0.015), which were affected by the calcium bath. These findings suggest that managing dialysate calcium baths impacts phosphaturic hormones and could be a critical factor in optimizing CKD-MBD treatment in PD patients, sparking a new avenue of research and potential interventions.
管理矿物质骨病（MBD）可降低心血管疾病风险并提高透析患者的生存率。我们的研究通过比较腹膜透析患者（PD，干预组）和血液透析患者（HD，对照组），聚焦于钙浴暴露对透析患者的影响。我们评估了多种因素，包括钙、磷、镁、甲状旁腺激素（PTH）、维生素D 25-羟基、C端肽（CTX）和成纤维细胞生长因子23（FGF-23）水平，以及采血前6小时的钙浴情况和每日钙暴露时长。我们纳入了40例PD患者和31例HD患者，平均年龄为68.7±13.6岁。我们的队列中PTH和FGF-23水平的中位数分别为194 ng/L（四分位间距[IQR] 130 - 316）和1296 pg/mL（IQR 396 - 2698）。我们确定1.25 mmol/L钙浴的暴露时长、磷酸盐水平和CTX是PTH的独立预测因素（分别为OR 0.279，P = 0.011；OR 0.277，P = 0.012；OR 0.11，P = 0.01）。相比之下，FGF-23的独立预测因素是磷酸盐水平（OR 0.48，P < 0.001）和血清钙水平（OR 0.25，P = 0.015），它们受到钙浴的影响。这些发现表明，管理透析液钙浴会影响排磷激素，可能是优化PD患者慢性肾脏病 - 矿物质和骨异常（CKD - MBD）治疗的关键因素，从而开辟了一条新的研究途径和潜在干预措施。
