Argilés A, Kerr P G, Canaud B, Flavier J L, Mion C
LP9008 CNRS, Centre de Recherches en Biochimie Macromoléculaire, Montpellier, France.
Kidney Int. 1993 Mar;43(3):630-40. doi: 10.1038/ki.1993.92.
The optimal dialysate calcium (Ca) content for hemodialysis has been classically fixed at 1.75 mM. However, this dialysate Ca concentration (dCa) with its positive intradialytic Ca balance combined with the use of CaCO3 as a phosphate binder may result in hypercalcemia. To prevent or treat hypercalcemia, a decrease in dCa has been proposed. In the present study both the acute and the long-term effects of lowering dCa were assessed. Additionally, given the results obtained after one year with low dCa the effectiveness of i.v. 1 alpha vitamin D3 in lowering PTH serum levels in two groups of patients dialyzed with different dCa was also studied. (a) Ca kinetics during hemodialysis (HD) and on line hemodiafiltration (HDF) were studied in a group of nine stable patients who were sequentially treated with 1.75, 1.5 and 1.25 mM dCa. Dialysate was the same but for the dCa which was lowered stepwise. Na, K, tCa, ionized Ca (iCa), proteins, phosphate and pH were measured from blood inlet and outlet and dialysate outlet at the start, one hour, two hours and after the treatments. At the same time weight, blood pressure and heart rate were recorded. The sieving of iCa was significantly different in HDF versus HD (F = 6.73; P < 0.01); intravenous infusion of 18 liters of filtered ultrapure dialysate compensated the Ca loss due to the convective component of HDF, as iCa was similar at the blood inlet in HD and HDF in the three dCa tested (F = 2.59; NS). Intradialytic iCa kinetics measured in the blood inlet were significantly different with different dCa (P < 0.001 for 1.75 mM vs. 1.5 mm and P < 0.001 for 1.5 mM vs. 1.25 mM). A significant increase in post-dialysis iCa was observed with dCa of 1.75 and 1.5 while no modification was observed with 1.25 mM dCa. (b) Regarding long-term effects of lowering dCa, seven of the nine patients acutely studied were followed for a one year period after changing from dCa = 1.5 to dCa = 1.25 mM. A control group of six patients was maintained with dCa = 1.5 for the same period of time and with the same treatment schedule but for dCa. Total Ca, phosphate and alkaline phosphatase were assessed monthly, and phosphate binders and oral vitamin D derivative doses were adapted accordingly. Intact PTH was determined quarterly. CaCO3 oral intake was more than doubled in the low dCa group. Total Ca, phosphate and ALP were similar in both groups over the assessed year.(ABSTRACT TRUNCATED AT 400 WORDS)
血液透析的最佳透析液钙（Ca）含量传统上固定为1.75 mM。然而，这种透析液钙浓度（dCa）及其透析内正钙平衡，再加上使用碳酸钙作为磷结合剂，可能会导致高钙血症。为预防或治疗高钙血症，有人提议降低dCa。在本研究中，评估了降低dCa的急性和长期影响。此外，鉴于低dCa治疗一年后获得的结果，还研究了静脉注射1α维生素D3对两组使用不同dCa进行透析的患者降低血清甲状旁腺激素（PTH）水平的有效性。（a）在一组9名稳定患者中研究了血液透析（HD）和在线血液透析滤过（HDF）期间的钙动力学，这些患者依次接受1.75、1.5和1.25 mM的dCa治疗。除了dCa逐步降低外，透析液相同。在开始、1小时、2小时及治疗后，从血液入口和出口以及透析液出口测量钠、钾、总钙（tCa）、离子钙（iCa）、蛋白质、磷酸盐和pH值。同时记录体重、血压和心率。HDF与HD相比，iCa的筛过率有显著差异（F = 6.73；P < 0.01）；静脉输注18升过滤后的超纯透析液补偿了HDF对流成分导致的钙损失，因为在三种测试的dCa条件下，HD和HDF血液入口处的iCa相似（F = 2.59；无显著性差异）。在血液入口处测量的透析内iCa动力学在不同dCa之间有显著差异（1.75 mM与1.5 mM相比，P < 0.001；1.5 mM与1.25 mM相比，P < 0.001）。观察到dCa为1.75和1.5时透析后iCa显著增加，而1.25 mM dCa时未观察到变化。（b）关于降低dCa的长期影响，在从dCa = 1.5改为dCa = 1.25 mM后，对急性研究的9名患者中的7名进行了为期一年的随访。一个由6名患者组成 的对照组在相同时间段内维持dCa = 1.5，治疗方案相同，但dCa不同。每月评估总钙、磷酸盐和碱性磷酸酶，并相应调整磷结合剂和口服维生素D衍生物的剂量。每季度测定完整PTH。低dCa组碳酸钙的口服摄入量增加了一倍多。在评估的一年中，两组的总钙、磷酸盐和碱性磷酸酶相似。（摘要截断于400字）
