中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (01): 25-29.doi: 10.3969/j.issn.1671-4091.2013.01.00

• 临床研究 • 上一篇    下一篇

维持性血液透析患者应用不同钙浓度透析液的钙平衡

张东亮,王丽妍,张爱华   

  1. 首都医科大学附属北京友谊医院肾内科
  • 收稿日期:2012-05-30 修回日期:2012-10-17 出版日期:2013-01-12 发布日期:2013-01-04
  • 通讯作者: 刘文虎 liuwh2002@yahoo.cn E-mail:zdlycy@sina.com
  • 基金资助:
    北京市科学技术委员会资助课题（课题编号：D09050704310903, Z121107001012138），首都卫生发展科研专项（编号：首发2011-2002-02）

Calcium mass balance in maintenance hemodialysis patients treated by dialysate with different calcium concentration

  • Received:2012-05-30 Revised:2012-10-17 Online:2013-01-12 Published:2013-01-04

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摘要： 【摘要】目的 对比不同钙浓度透析液透析过程中钙转运的量及48小时钙平衡。方法 随机抽取20例维持性血液透析患者，分别给予钙浓度为1.50mmol/L和1.75mmol/L的透析液进行常规血液透析各1周，计算透析过程中钙转运量（calcium mass transfer, CMT），记录患者48小时饮食及服用碳酸钙和骨化三醇的情况，估算食物钙含量、钙剂含钙量、维生素D3摄入量，计算消化道钙吸收量（CaAbs）。结合CMT与CaAbs计算钙平衡（calcium mass balance, CMB）。分别对CMT、CMB与其他参数进行相关性分析。 结果 测算得两种透析液治疗CMT差异无显著性，tCMT分别为3.44±8.58（mmol）和7.43±10.97（mmol），P=0.256；CaAbs差异无显著性，145.6±92.1（mg）对146.3±92.7（mg），P=0.388；CMB48h差异无显著性，268.2±364.9（mg）对443.4±438.1（mg），P=0.215。其中tCMT的相关因素为透析废液量（B = -1.50）和新-废透析液总钙浓度差ΔtCaF-S（B = 120.24） ，CMB48h的相关因素则只有tCMT（B = 39.51），P均<0.001。结论 使用1.50mmol/L和1.75mmol/L钙透析液透析均使钙向MHD患者体内转运，二者转运量相当；透析过程中钙转运是MHD患者钙平衡的关键因素，透析钙转运量受超滤除水量和透析液钙浓度影响。

关键词: 血液透析, 透析液, 钙平衡, 钙转运, 离子钙

Abstract: Abstract Target To compare the differences on calcium mass balance in maintenance hemodialysis patients treated by dialysates with different calcium concentration. Methods In a single hemodialysis center, 20 maintenance hemodialysis patients were rolled into the study randomly. Different calcium dialysates, 1.50mmol/L and 1.75mmol/L, were used for 20 patients in standard hemodialysis treatment for three times, respectively. The calcium mass transfer (CMT) during one hemodialysis session by using different calcium dialysates were calculated respectively. The calcium intake of diet and calcium binder was recorded. The calcium absorption from intestine (CaAbs) and calcium mass balance during 48 hours (CMB48h) was calculated. The relationships among CMT, CMB48h and other parameters were tested. Results There were no significant differences on total calcium mass transfer (tCMT) , CaAbs, and CMB48h between two different calcium dialysate treatments, 3.44±8.58（mmol） vs. 7.43±10.97（mmol）, P=0.256, 145.6±92.1（mg） vs. 146.3±92.7（mg）, P=0.388, 268.2±364.9（mg）vs. 443.4±438.1（mg）, P=0.215, respectively. The correlated factors of tCMT were spent dialysate volume and ΔtCaF-S, B = -1.50 and 120.24, respectively, P<0.001. The tCMT was the only correlated factor of CMB48h, B = 39.51, P<0.001. Conclusions The calcium mass transfers from dialysate to blood during hemodialysis treatment by using 1.50mmol/L and 1.75mmol/L calcium dialysates. The differences on tCMT between the different calcium dialysates therapy were no significant. The tCMT was the important factor for CMB48h. The tCMT during hemodialysis were affected by ultrafiltration volume and the calcium concentration of dialysate.

Key words: hemodialysis, dialysate, calcium mass balance, calcium mass transfer, ionized calcium