Kovarik J, Graf H, Stummvoll H K, Wolf A, Pinggera W
Wien Klin Wochenschr. 1979 Nov 23;91(22):765-8.
A study was carried out in 25 patients on chronic intermittent haemodialysis on the effect of increasing the dialysate calcium concentration from 1.5 to 1.75 mMol/l on calcium and phosphorus metabolism. In 16 patients the increase in the dialysate calcium resulted in a sufficiently large increase in the plasma Ca level to suppress the parathyroid glands. The calcium influx during dialysis in these patients was sufficient to abolish the effects of diminished calcium absorption from the intestine due to loss of endocrine renal function. The remaining 9 patients showed no suppression of parathyroid gland activity and could be separated into two different groups, one requiring calcium supplementation and the other group manifesting signs of autonomic hyperparathyroidism. The five patients showing a higher calcium requirement were started on active vitamin D metabolites. In the remaining 4 patients parathyroidectomy will probably be inevitable if progression of the clinical manifestations of hyperparathyroidism occurs. Close control of plasma phosphorus levels is mandatory to avoid an increase in the calcium phosphate product or the danger of hypophosphataemic osteomalacia.
对25例慢性间歇性血液透析患者进行了一项研究，观察将透析液钙浓度从1.5毫摩尔/升提高到1.75毫摩尔/升对钙和磷代谢的影响。在16例患者中，透析液钙浓度的增加导致血浆钙水平充分升高，从而抑制甲状旁腺。这些患者透析期间的钙内流足以消除因肾脏内分泌功能丧失导致肠道钙吸收减少的影响。其余9例患者甲状旁腺活动未受抑制，可分为两个不同组，一组需要补充钙，另一组表现出自主性甲状旁腺功能亢进的体征。对5例钙需求量较高的患者开始使用活性维生素D代谢物治疗。如果甲状旁腺功能亢进的临床表现继续发展，其余4例患者可能不可避免地需要进行甲状旁腺切除术。必须严格控制血浆磷水平，以避免磷酸钙乘积增加或发生低磷性骨软化症的风险。
