O'Hare J A, Murnaghan D J
Am J Med. 1984 Aug;77(2):229-32. doi: 10.1016/0002-9343(84)90696-x.
High-aluminum dialysate exposure has been incriminated in the pathogenesis of vitamin D-resistant osteomalacia in patients undergoing long-term hemodialysis. Parathyroid-mediated osteitis fibrosa is rare in these patients. Thirteen patients undergoing longterm hemodialysis were transferred from a center (Unit A) where water used to prepare dialysate was high in aluminum (100 to 450 micrograms/liter) to a new center (Unit B) where dialysate was highly purified (aluminum concentration less than 10 micrograms/liter), and changes in calcium metabolism were studied over a 12-month period. After transfer of patients to Unit B, serum aluminum levels fell (p less than 0.01), whereas serum immunoreactive parathyroid hormone levels rose (p less than 0.01) over 10 months. Over this time, predialysis serum calcium levels did not alter significantly, whereas postdialysis serum calcium levels declined slightly (p less than 0.05). Serum phosphate levels did not alter. Serum alkaline phosphatase levels rose progressively in Unit B (p less than 0.001). Discontinuation of dialysate high in aluminum in patients undergoing long-term hemodialysis may facilitate a rise in parathyroid activity.
长期血液透析患者中，高铝透析液暴露被认为与维生素D抵抗性骨软化症的发病机制有关。甲状旁腺介导的纤维性骨炎在这些患者中较为罕见。13名长期血液透析患者从一个中心（A单位）转至一个新中心（B单位），A单位用于制备透析液的水中铝含量较高（100至450微克/升），而B单位的透析液经过高度纯化（铝浓度低于10微克/升），并在12个月期间研究了钙代谢的变化。患者转至B单位后，血清铝水平下降（p<0.01），而血清免疫反应性甲状旁腺激素水平在10个月内上升（p<0.01）。在此期间，透析前血清钙水平无明显变化，而透析后血清钙水平略有下降（p<0.05）。血清磷水平未改变。B单位血清碱性磷酸酶水平逐渐升高（p<0.001）。长期血液透析患者停用高铝透析液可能会促使甲状旁腺活性升高。
