Effect Of Low Calcium Dialysate On Calcium And Phosphorus Metabolism And Intact Parathyroid Hormone In Maintenance Hemodialysis Patients

Objective:To explore the effects of long-term application of low calcium dialysate on calcium and phosphorus metabolism and intact parathyroid hormone in Maintenance Hemodialysis Patients.Method:A total of 89 patients with MHD were included.The general data of the included subjects were collected and dialysis with low calcium dialysate(LCD)of 1.25 mmol/L calcium concentration for 1 year.Baseline values before dialysis application and 3,6 after application were recorded respectively,9 and 12 months of calcium(calcium,Ca),phosphorus(phosphorus,P),intact parathyroid hormone(iPTH)and alkaline phosphatase(alkaline phosphatase,ALP)levels,observe The effect of long-term application of LCD on the above indicators.Based on this,iPTH levels were divided into three subgroups of <150 pg/m L,150 pg/m L to 300 pg/m L,and >300 pg/m L.The effects of LCD on Ca,P,iPTH,and ALP in MHD patients with different iPTH were observed.According to the serum Ca level,it was divided into three subgroups: <2.1mmol/L,2.1mmol/L ? 2.37mmol/L,> 2.37mmol/L,and the LCD was observed for the Ca,P,iPTH,ALP of MHD patients with different Ca levels.influences.Results:1.MHD patients use LCD dialysate for hemodialysis for 12 months.With the extension of dialysis time,the levels of blood Ca and P decrease,and the levels of iPTH and ALP increase.(1)Serum Ca gradually decreased,and the monthly Ca value compared with baseline P<0.05.(2)Serum P gradually decreased.After 6 months,P value compared with baseline P<0.05.(3)iPTH gradually increased,and the iPTH value of each month was compared with baseline P<0.05.(4)ALP gradually increased,and the ALP value of each month compared with baseline was P<0.05.2.Subgroups at different levels of iPTH:When iPTH <150pg / m L,there is no obvious change in blood Ca,blood P has a downward trend,iPTH and ALP increase;When iPTH 150 pg / m L ? 300 pg / m L,blood Ca decreased,blood P showed a downward trend,iPTH,ALP increased;When iPTH> 300 pg / m L,blood Ca decreased,blood P decreased,and iPTH and ALP increased.(1)Group with iPTH <150pg / m L(18 cases):(1)No significant change in serum Ca,P> 0.05;(2)Serum P gradually declined,but P> 0.05;(3)iPTH gradually increased,P <0.05;(4)ALP gradually increased,P <0.05.(2)The iPTH 150 pg / m L ? 300 pg / m L group(45 cases):(1)Serum Ca gradually decreased,P <0.05;(2)Serum P gradually declined,but P> 0.05;(3)iPTH gradually increased,P <0.05;(4)ALP gradually increased,P <0.05.(3)iPTH> 300 pg / m L group(26 cases):(1)Serum Ca gradually decreased,P <0.05;(2)Serum P gradually declined,but P> 0.05;(3)iPTH gradually increased,but P> 0.05;(4)ALP gradually increased,but P> 0.05.3.Subgroups with different levels of blood Ca:Regardless of blood Ca <2.1mmol / L,blood Ca2.1mmol / L ? 2.37 mmol / L or blood Ca> 2.37 mmol / L,as the dialysis time increases,blood Ca gradually decreases,blood P has a downward trend,iPTH,ALP Rise.(1)Ca <2.1mmol / L group(12 cases):(1)Serum Ca gradually decreased,P <0.05;(2)Serum P gradually declined,but P> 0.05;(3)iPTH gradually increased,P <0.05;(4)ALP gradually increased,P <0.05.(2)Ca 2.1mmol / L ? 2.37 mmol / L group(52 cases):(1)Serum Ca gradually decreased,P <0.05;(2)Serum P gradually declined,but P> 0.05;(3)iPTH gradually increased,P <0.05;(4)ALP gradually increased,P <0.05.(3)Ca> 2.37 mmol / L group(25 cases):(1)Serum Ca gradually decreased,P <0.05;(2)Serum gradually declined,but P> 0.05;(3)iPTH gradually increased,P <0.05;(4)ALP gradually increased,P <0.05.Conclusion:1.You can see by applying LCD dialysate to MHD patients for 12 months,With the prolongation of dialysis time,low-calcium dialysate will have a certain effect on patients' blood Ca,P and iPTH,ALP levels,which can reduce blood Ca and P levels and increase iPTH and ALP levels.2.The results of the subgroups at different levels of iPTH indicate that no matter what level the iPTH is at,The application of LCD can lead to the decrease of blood Ca and P and the increase of iPTH and ALP.Therefore,it is more suitable for patients with iPTH <150pg / m L.For patients with iPTH> 300 pg / m L,it should be used cautiously and closely monitored.Although patients with 150 pg / m L <iPTH <300pg / m L are suitable for application,they still need to be monitored.3.The results of subgroups with different levels of blood Ca indicate that as the dialysis time increases,The levels of blood Ca and P are reduced,and the levels of iPTH and ALP are increased.Therefore,LCD is prone to hypocalcium-related complications in patients with hypocalcemia.It is best combined with the application of calcium.It is suitable for patients with normal or elevated blood calcium to use LCD dialysis,but it should be combined with the comprehensive evaluation of patients' iPTH and ALP levels.At the same time,attention should be paid to the changes of blood Ca,P and iPTH,ALP.