Hutchison A J, Gokal R
Renal Dialysis Unit, Royal Infirmary, Manchester, United Kingdom.
Adv Perit Dial. 1993;9:253-6.
Recognition of the harmful effects of aluminum, its replacement by calcium salts, the introduction of reduced calcium dialysis fluid, and the availability of sensitive and specific assays for intact 1-84PTH have resulted in changes in the monitoring and management of renal osteodystrophy in continuous ambulatory peritoneal dialysis (CAPD). In addition, better understanding of the calcitriol/parathyroid axis enables a more structured approach to the treatment of patients with established hyperparathyroid bone disease. Wherever possible, CAPD patients should undergo tetracycline labeled bone biopsy at the time of starting dialysis in order to establish the exact bone histology. Thereafter management can be rationally decided on the basis of regular monitoring of serum intact parathyroid hormone (iPTH). Routine prophylactic use of calcitriol is unnecessary, but when iPTH levels rise, despite strict control of calcium and phosphate levels, oral pulse therapy is an effective and inexpensive method of controlling hyperparathyroidism. However, long-term histological studies of its benefit are awaited.
认识到铝的有害影响、用钙盐替代铝、引入低钙透析液以及有了针对完整的1-84甲状旁腺激素（PTH）的灵敏且特异的检测方法，已导致持续性非卧床腹膜透析（CAPD）中肾性骨营养不良的监测和管理发生了变化。此外，对骨化三醇/甲状旁腺轴有了更好的理解，使得能够以更有条理的方式治疗已确诊的甲状旁腺功能亢进性骨病患者。只要有可能，CAPD患者在开始透析时应进行四环素标记的骨活检，以便确定确切的骨组织学情况。此后，可根据对血清完整甲状旁腺激素（iPTH）的定期监测合理地决定管理方案。常规预防性使用骨化三醇没有必要，但当iPTH水平升高时，尽管严格控制了钙和磷水平，口服脉冲疗法仍是控制甲状旁腺功能亢进的一种有效且廉价的方法。然而，其益处的长期组织学研究尚在期待之中。
