| Objective:To analysis the effect of peritoneal dialysis fluid with different calcium concentration on serum calcium,phosphate and parathyroid hormone among continuous ambulatory peritoneal dialysis patients.Methods:94 patients with chronic kidney disease were enrolled in this study.They underwent peritoneal dialysis catheterization in the Department of Nephrology of The First Affiliated Hospital of Guangxi Medical University and maintenance peritoneal dialysis treatment followed up for 1-2 years during Jan,2013 to Jan,2017,excluding patients who were treated with peritoneal dialysis combined with hemodialysis,and alternately used different calcium concentrations.Basic information and clinical indicators of these patients were collected,including gender,age,from urban or rural,the primary disease,body mass index,systolic blood pressure,diastolic blood pressure,calcification of thoracic aorta,serum creatinine,serum calcium,serum phosphorus,parathyroid hormone.According to the concentration of calcium ions in peritoneal dialysis fluid,patients were divided into the standard calcium transdermal fluid group?abbreviates as standard calcium group,n=50?and the low calcium transdermal fluid group?abbreviates as low calcium group,n=44?.To compare serum calcium,phosphorus and iPTH levels between groups at baseline,the twelfth month and the twenty-fourth month of follow-up.To analyze the reaching guide target rate of serum calcium and phosphorus in each group.Results:1.General information:Among the 94 peritoneal dialysis patients,57 males and 37 women,their average age were 44.97±13.21 years old.62.8%patients came from rural areas and 37.2%from urban areas.The first three protopathy of these PD patients in our study were chronic glomerulonephritis?72.3%?,hypertensive nephropathy?8.5%?and diabetic nephropathy?6.4%?.2.The twelfth month of followed up:?1?There was no difference in serum albumin level between baseline and the 12th month of follow-up?t=-1.165,P=0.247?.?2?At the 12th month of follow-up,the corrected serum calcium level of 94 PD patients was higher than the baseline,and the difference had statistically significance?t=-7.857,P<0.001?.Compared with the baseline,the level of serum phosphorus significantly decreased?t=4.391,P<0.001?.The iPTH level was no significant difference compared baseline with the 12th month of follow-up?Z=-0.156,P=0.880?.?3?The control rates of serum calcium,phosphorus and iPTH at baseline and the 12th month of follow-up were 55.3%?18.1%?61.7%and 75.5%?55.3%?71.3%.After one year treatment,the control rate of serum calcium and phosphorus was increased?P=0.002,P<0.001?,meanwhile there was no difference in the control rate of serum iPTH?P=0.188?.?4?At the baseline and the 12th month of follow-up,the level of serum calcium?t=-0.091,P=0.927;t=0.842,P=0.402?,phosphorus?t=0.271,P=0.787;t=1.206,P=0.231?and iPTH?Z=-0.621,P=0.534;Z=-1.606,P=0.108?between the standard calcium group and the low calcium group was no difference.Compared the interior of groups,at the 12th month of follow-up the corrected serum calcium level?t=-6.117,P<0.001;t=-4.923,P<0.001?)was both increased and serum phosphorus level decreased?t=2.906,P=0.005;t=3.279,P=0.002?,but the two groups'iPTH level were no be changed?Z=-1.018,P=0.380;Z=-1.332,P=0.183?.?5?In the oral calcium group,some patients were using standard calcium peritoneal dialysis fluid,whlie the others using low calcium peritoneal dialysis fluid.At baseline and the 12th month of follow-up,there was no difference in serum calcium?t=-0.500,P=0.620;t=-0.253,P=0.801?,phosphorus?t=0.984,P=0.330;t=0.854,P=0.398?andiPTH?Z=0.536,P=0.592;Z=-0.364,P=0.716?between the two groups.Respectively compared the interior of this two groups,at the 12th month,two grousps'serum calcium level increased together?t=-5.725,P<0.001;t=-3.479,P=0.002?,serum phosphoruslevel decreased together?t=3.029,P=0.005;t=2.301,P=0.032?,and iPTH level all showed no change?Z=-0.195,P=0.845;Z=-0.402,P=0.687?.?6?In the non-oral calcium group,some patients were using standard calcium peritoneal dialysis fluid,whlie the others using low calcium peritoneal dialysis fluid.Compared the two groups,the serum calcium levels was no difference in baseline?t=1.709,P=0.095?,but at the 12th month of follow-up,the serum calcium level of patients who were using standard calcium peritoneal dialysis fluid was higher than that of patients who were using low calcium peritoneal dialysis fluid?t=2.094,P=0.045?.Respectively compared the interior of this two groups,at baseline and the 12th month,serum calcium level increased together?t=-2.768,P=0.012;t=-4.118,P<0.001?,and iPTH level was not changed?Z=-1.568,P=0.117;Z=-1.430,P=0.153?,but serum phosphorus level of the standard calcium group was unchange?t=1.015,P=0.323?,while the low calcium group'serum phosphorus declined?t=2.370,P=0.027?.3.The twenty-fourth month of follow-up:There was no difference in the level of the serum calcium?t=0.778,P=0.440?,phosphorus?t=-0.819,P=0.416?and iPTH?Z=-0.884,P=0.399?and the control ratio of calcium?P=0.064?,phosphorus?P=0.832?between the twelfth month of follow-up and the twenty-fourth.At the the twenty-fourth month,the corrected serum calcium level of the standard calcium group was higher than that it in the low calcium group?t=4.673,P<0.001?,meanwhile there was no difference in serum phosphorus?t=1.552,P=0.125?and iPTH?Z=-1.295,P=0.195?between this two groups.Respectively compared the interior of this two groups,the serum calcium level of the standard calcium group increased at the 24th month?t=-3.136,P=0.003?.But the serum calcium level of the low calcium group at the 24th month was unchanged?t=2.016,P=0.053?.At the follow-up of the twenty-fourth month,the incidence of hypercalcemia in the standard calcium group was higher than that in the low calcium PD group(??17?=6.188,P=0.013),and the incidence of hypocalcemia in the low calcium group was higher than that in the standard calcium group(??17?=7.093,P=0.013).4.At the twenty-fourth month,the utilization rate of calcium and vitamin D and its analogues in the low calcium group was higher than that in the standard calcium group(??17?=4.773,P=0.029).Conclusion:1.Within 24 months of the continuous ambulatory peritoneal dialysis,using the standard calcium or the low calcium peritoneal dialysis fluid could improve patients'hyperphosphatemia and hypocalcemia and increase the control rate of serum calcium and phosphorus,but during the follow-up period there was no change in the level of serum iPTH.2.Within one year of peritoneal dialysis,the influence of the standard calcium peritoneal dialysis and the low calcium peritoneal dialysis on the level of serum calcium,phosphorus and iPTH of patients was no difference.3.Peritoneal dialysis for two years,the serum calcium level and the rate of hypercalcemia of patients who were using the standard calcium peritoneal dialysis was higher than that using the low calcium peritoneal dialysis.4.Within two years,the impact of the standard calcium peritoneal dialysis and the low calcium peritoneal dialysis on the level of serum phosphorus and iPTH of peritoneal dialysis patients was no difference. |
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