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首页> 外文期刊>Sao Paulo Medical Journal >Effects of in-center daily hemodialysis upon mineral metabolism and bone disease in end-stage renal disease patients
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Effects of in-center daily hemodialysis upon mineral metabolism and bone disease in end-stage renal disease patients

机译：中心每日血液透析对终末期肾脏疾病患者矿物质代谢和骨骼疾病的影响

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CONTEXT: Alternative hemodialysis schedules have been proposed to improve the quality of the dialysis. Nonetheless, their influence upon mineral and bone disorders is unknown. OBJECTIVE: To report the impact of a daily hemodialysis schedule upon the lesions of renal osteodystrophy. TYPE OF STUDY: Prospective non-controlled study. SETTING: Public University Hospital. PARTICIPANTS: Five patients treated by daily hemodialysis for at least 24 months. INTERVENTION: Daily dialysis sessions were accomplished with non-proportional dialysis machines without an ultrafiltration control device, with blood flow of 300 ml/min, bicarbonate dialysate ([Ca]=3.5 mEq/L) at 500 ml/min, and low-flux membrane dialyzers. Sessions were started at 6:00 p.m. (except Sundays) and lasted 2 hours. MAIN MEASUREMENTS: Serum levels of Ca and P from the last 6 months on conventional hemodialysis for the same patients were used for comparison with each semester of daily hemodialysis. Bone biopsies and PTH levels were obtained at the end of the conventional hemodialysis period and then again after 2 years of daily hemodialysis. RESULTS: Mean serum calcium was significantly higher during the second and third semesters of daily dialysis [10.0 mg% (SD 0.6), and 10.0 mg% (SD 0.8), respectively] compared to standard dialysis [9.4 mg% (SD 0.8)], p < 0.05. Mean values for phosphorus were significantly lower during every semester of daily hemodialysis [6.3 mg% (SD 1.8), 5.8 mg% (SD 1.7), 6.0 mg% (SD 1.7), and 6.0 mg% (SD 1.8)] compared to standard dialysis [7.2 mg% (SD 2.7)], P < 0.05. Variations in mean Ca x P product followed the same pattern as for phosphorus [59.5 (SD 16.0), 57.1 (SD 16.3), 59.8 (SD 17.7), and 58.31 (SD 20.9) vs. 68.6 (SD 27.3), P < 0.05]. After 2 years on daily hemodialysis, 2 patients who had aplastic lesion were found to have mild bone disorder. In addition, one patient with mixed bone lesion and moderate bone aluminum accumulation had osteitis fibrosa with no aluminum. Intact PTH values at the beginning of study and after 2 years on daily hemodialysis did not differ [134 pg/ml (SD 66) vs. 109 pg/ml (SD 26), P = 0.60, respectively]. CONCLUSIONS: Patients treated using daily hemodialysis had better control of serum phosphorus and perhaps a lower risk of metastatic calcifications. Daily hemodialysis also seemed to be beneficial to low turnover bone disease and bone aluminum deposition.
机译：背景：已经提出了替代性血液透析时间表以提高透析质量。但是，它们对矿物质和骨骼疾病的影响尚不清楚。目的：报告每日血液透析时间表对肾性骨营养不良病变的影响。研究类型：前瞻性非对照研究。地点：公立大学医院。研究对象：五名接受每日血液透析治疗至少24个月的患者。干预：日常透析是通过不带超滤控制装置的非比例透析机完成的，血液流量为300 ml / min，碳酸氢根透析液（[Ca] = 3.5 mEq / L），流速为500 ml / min，通量低膜透析器。会议于下午6:00开始。 （星期日除外），持续了2个小时。主要测量：同一患者在常规血液透析中最近6个月的血清Ca和P水平与每日血液透析的每学期进行比较。在常规血液透析期结束时，然后在每天进行2年血液透析后，再次获得骨活检和PTH水平。结果：与标准透析[9.4 mg％（SD 0.8）]相比，每日透析的第二和第三学期的平均血清钙水平显着更高[分别为10.0 mg％（SD 0.6）和10.0 mg％（SD 0.8）]。 ，p ＜0.05。与标准相比，每日血液透析每学期的磷平均值显着降低[6.3 mg％（SD 1.8），5.8 mg％（SD 1.7），6.0 mg％（SD 1.7）和6.0 mg％（SD 1.8）]透析[7.2 mg％（SD 2.7）]，P <0.05。 Ca x P乘积的平均值与磷的变化规律相同[59.5（SD 16.0），57.1（SD 16.3），59.8（SD 17.7）和58.31（SD 20.9）与68.6（SD 27.3），P <0.05 ]。每天进行2年血液透析后，发现2例再生障碍性病变患者患有轻度骨病。此外，一名混合性骨病变和中度骨铝积聚的患者患有纤维性骨炎，无铝。研究开始时和每日血液透析2年后的完整PTH值没有差异[134 pg / ml（SD 66）vs. 109 pg / ml（SD 26），P = 0.60]。结论：每天进行血液透析治疗的患者对血磷的控制更好，转移钙化的风险可能更低。每日血液透析似乎也有利于低周转率的骨病和骨铝沉积。

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