Analysis of the effects of dialysate calcium concentrations on mineral and bone metabolism in patients with long-term CAPD

doi:10.3877/cma.j.issn.2095-3216.2015.05.006

Abstract

Abstract:

Objective

To investigate the effects of dialysate calcium concentrations on on mineral and bone metabolism in patients with continuous ambulatory peritoneal dialysis (CAPD).

Methods

A retrospective analysis was made in our hospital for more than two years in 123 patients with CAPD treatment, who were divided into low calcium dialysate (LCD) group (calcium concentration 1.25 mmol/L) and standard calcium dialysate (SCD) group (calcium concentration 1.75 mmol/L) to observe their effects on serum calcium, phosphorus, intact parathyroid hormone (iPTH), bone pain, pruritus, thickness of carotid arteries, and heart valve calcification.

Results

There were no differences in baseline levels of demographic characteristics, peritoneal transport characteristics, and calcium phosphorus metabolism between the two groups (P>0.05). After 2 years of treatment, serum calcium concentration and the target-reaching rate significantly increased in the two groups compared with those before treatment (P<0.05), and the calcium concentration of SCD group was higher than that of the LCD group but without statistical significance (0.26±0.31 mmol/L vs 0.17±0.29 mmol/L, t=1.621, P=0.108); and the differences between the two groups after treatment were not statistically significant in the serum calcium, phosphorus, the average level of iPTH and its target-reaching rate, carotid artery thickness, cardiac valve calcification proportion, bone pain, and cumulative incidence rate of skin itching (P>0.05); but the proportion of active vitamin D use in LCD group was significantly higher than that in the SCD group (χ²=6.373, P<0.05).

Conclusion

The treatment of CAPD with different dialysate calcium concentrations for 2 years did not have any significant effects on the mineral and bone metabolism of patients.

Key words: Peritoneal dialysis, Peritoneal dialysis solution, Parathyroid hormone, Calcium and phosphorus metabolism

Jie Yang, Jurong Yang, Bengang Huo, Mingyu Cai, Jianguo Zhang, Wenjiang Gong, Yan Yu, Yani He. Analysis of the effects of dialysate calcium concentrations on mineral and bone metabolism in patients with long-term CAPD[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(05): 246-250.

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References 20

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分组	例数	年龄(岁)	性别(男/女)	体质量指数(kg/m²)	尿量(ml/24 h)	腹膜转运特性[例(%)]
分组	例数	年龄(岁)	性别(男/女)	体质量指数(kg/m²)	尿量(ml/24 h)	高转运	高平均转运	低转运	低平均转运
LCD组	66	50.50±16.75	43/23	21.72±2.92	889.39±462.81	9(13.64)	34(51.52)	1(1.52)	22(33.33)
SCD组	57	49.28±18.51	37/20	21.70±3.13	869.30±414.23	10(17.54)	24(42.11)	3(5.26)	20(35.09)
检验值	?	t＝0.443	χ²＝0.001	t＝0.051	t＝0.252	χ²＝0.358	χ²＝1.087	χ²＝0.434	χ²＝0.042
P值		0.702	0.978	0.959	0.801	0.550	0.297	0.510	0.838
分组	?	估算的肾小球滤过率(ml/min)	总KT/V	总肌酐清除率(L/周)	超滤量(ml/d)	Hb(g/L)	血清白蛋白(g/L)
LCD组	66	3.56(1.70，5.90)	1.81(1.46，2.47)	66.53(49.59，93.18)	303.79±453.73	83.92±18.75	32.34±5.06
SCD组	57	2.79(1.83，6.33)	1.69(1.40，2.13)	53.90(39.25，85.08)	429.82±397.07	87.38±19.11	33.42±5.4
检验值	?	U＝0.109	t＝1.481	U＝1.407	t＝1.627	t＝1.154	t＝1.148
P值	?	0.913	0.139	0.162	0.106	0.317	0.253

分组	例数	年龄(岁)	性别(男/女)	体质量指数(kg/m²)	尿量(ml/24 h)	腹膜转运特性[例(%)]
分组	例数	年龄(岁)	性别(男/女)	体质量指数(kg/m²)	尿量(ml/24 h)	高转运	高平均转运	低转运	低平均转运
LCD组	66	50.50±16.75	43/23	21.72±2.92	889.39±462.81	9(13.64)	34(51.52)	1(1.52)	22(33.33)
SCD组	57	49.28±18.51	37/20	21.70±3.13	869.30±414.23	10(17.54)	24(42.11)	3(5.26)	20(35.09)
检验值	?	t＝0.443	χ²＝0.001	t＝0.051	t＝0.252	χ²＝0.358	χ²＝1.087	χ²＝0.434	χ²＝0.042
P值		0.702	0.978	0.959	0.801	0.550	0.297	0.510	0.838
分组	?	估算的肾小球滤过率(ml/min)	总KT/V	总肌酐清除率(L/周)	超滤量(ml/d)	Hb(g/L)	血清白蛋白(g/L)
LCD组	66	3.56(1.70，5.90)	1.81(1.46，2.47)	66.53(49.59，93.18)	303.79±453.73	83.92±18.75	32.34±5.06
SCD组	57	2.79(1.83，6.33)	1.69(1.40，2.13)	53.90(39.25，85.08)	429.82±397.07	87.38±19.11	33.42±5.4
检验值	?	U＝0.109	t＝1.481	U＝1.407	t＝1.627	t＝1.154	t＝1.148
P值	?	0.913	0.139	0.162	0.106	0.317	0.253

组别	例数	治疗前
组别	例数	血清钙(mmol/L)	低钙患者[例数(%)]	高钙患者[例数(%)]	血清钙达标率(%)	血清磷(mmol/L)	低磷患者[例数(%)]	高磷患者[例数(%)]	血清磷达标率(%)
LCD组	66	2.02±0.25	38(57.58%)	0(0%)	42.42%	1.84±0.53	3(4.55%)	34(51.52%)	43.94%
SCD组	57	1.99±0.25	37(64.91%)	1(1.75%)	33.33%	1.95±0.64	4(7.02%)	32(56.14%)	36.84%
检验值	?	t＝0.705	χ²＝0.692	χ²＝0.005	χ²＝1.071	t＝1.085	χ²＝0.04	χ²＝0.263	χ²＝0.639
P值	?	0.089	0.154	0.842	0.342	0.151	0.809	0.148	0.205
组别	例数	治疗后
组别	例数	血清钙(mmol/L)	低钙患者[例数(%)]	高钙患者[例数(%)]	血清钙达标率(%)	血清磷(mmol/L)	低磷患者[例数(%)]	高磷患者[例数(%)]	血清磷达标率(%)
LCD组	66	2.19±0.17	16(24.24%)	3(4.55%)	71.21%	1.79±0.58	5(7.58%)	28(42.42%)	50.00%
SCD组	57	2.25±0.19	8(14.04%)	4(7.02%)	78.95%	1.65±0.49	5(8.77%)	17(29.82%)	61.40%
检验值	?	t＝1.716	χ²＝2.029	χ²＝0.04	χ²＝0.971	t＝1.444	χ²＝0.059	χ²＝2.093	χ²＝1.609
P值		0.089	0.154	0.842	0.342	0.151	0.809	0.148	0.205
检验值1	?	t＝5.03	χ²＝15.168	χ²＝1.364	χ²＝11.147	t＝0.488	χ²＝0.133	χ²＝1.095	χ²＝0.487
P值1		0	0	0.243	0.001	0.627	0.715	0.295	0.485
检验值2	?	t＝6.289	2＝30.877	χ²＝0.837	χ²＝24.083	t＝3.15	χ²＝0	χ²＝8.053	χ²＝6.879
P值2		0	0	0.36	0	0.003	1	0.005	0.009

组别	例数	治疗前
组别	例数	血清钙(mmol/L)	低钙患者[例数(%)]	高钙患者[例数(%)]	血清钙达标率(%)	血清磷(mmol/L)	低磷患者[例数(%)]	高磷患者[例数(%)]	血清磷达标率(%)
LCD组	66	2.02±0.25	38(57.58%)	0(0%)	42.42%	1.84±0.53	3(4.55%)	34(51.52%)	43.94%
SCD组	57	1.99±0.25	37(64.91%)	1(1.75%)	33.33%	1.95±0.64	4(7.02%)	32(56.14%)	36.84%
检验值	?	t＝0.705	χ²＝0.692	χ²＝0.005	χ²＝1.071	t＝1.085	χ²＝0.04	χ²＝0.263	χ²＝0.639
P值	?	0.089	0.154	0.842	0.342	0.151	0.809	0.148	0.205
组别	例数	治疗后
组别	例数	血清钙(mmol/L)	低钙患者[例数(%)]	高钙患者[例数(%)]	血清钙达标率(%)	血清磷(mmol/L)	低磷患者[例数(%)]	高磷患者[例数(%)]	血清磷达标率(%)
LCD组	66	2.19±0.17	16(24.24%)	3(4.55%)	71.21%	1.79±0.58	5(7.58%)	28(42.42%)	50.00%
SCD组	57	2.25±0.19	8(14.04%)	4(7.02%)	78.95%	1.65±0.49	5(8.77%)	17(29.82%)	61.40%
检验值	?	t＝1.716	χ²＝2.029	χ²＝0.04	χ²＝0.971	t＝1.444	χ²＝0.059	χ²＝2.093	χ²＝1.609
P值		0.089	0.154	0.842	0.342	0.151	0.809	0.148	0.205
检验值1	?	t＝5.03	χ²＝15.168	χ²＝1.364	χ²＝11.147	t＝0.488	χ²＝0.133	χ²＝1.095	χ²＝0.487
P值1		0	0	0.243	0.001	0.627	0.715	0.295	0.485
检验值2	?	t＝6.289	2＝30.877	χ²＝0.837	χ²＝24.083	t＝3.15	χ²＝0	χ²＝8.053	χ²＝6.879
P值2		0	0	0.36	0	0.003	1	0.005	0.009

组别	例数	治疗前
组别	例数	iPTH (ng/L)	低iPTH患者[例数(%)]	高iPTH[例数(%)]	iPTH达标率(%)
LCD组	66	278.08(146.66，418.76)	13(19.7%)	7(10.61%)	69.70%
SCD组	57	312.48(204.20，533.06)	4(7.02%)	10(17.54%)	75.44%
检验值	?	U＝3.097	χ²＝3.132	χ²＝1.236	χ²＝0.504
P值		0.078	0.077	0.266	0.478
组别	例数	治疗后
组别	例数	iPTH (ng/L)	低iPTH患者[例数(%)]	高iPTH[例数(%)]	iPTH达标率(%)
LCD组	66	256.81(173.55，356.80)	12(18.18%)	5(7.58%)	74.24%
SCD组	57	241.60(124.40，362.65)	15(26.32%)	5(8.77%)	64.91%
检验值	?	U＝0.587	χ²＝0.996	χ²＝0.059	χ²＝1.266
P值		0.444	0.318	0.809	0.261
检验值1	?	U＝0.501	χ²＝0.019	χ²＝0.367	χ²＝0.338
P值1		0.616	0.891	0.545	0.561
检验值2	?	U＝2.968	χ²＝6.316	χ²＝1.919	χ²＝1.509
P值2		0.003	0.012	0.166	0.219

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