Abstract：
In recent years, adynamic bone disease (ABD) has become a common skeletal lesion in adult patients with chronic kidney disease. We aimed to compare the effects of low calcium dialysate (LCD) and standard calcium dialysate of our facility [high calcium dialysate (HCD)] on the evolution of bone and mineral parameter related to ABD in dialysis patients. Forty patients with predialysis intact parathyroid hormone (iPTH) <100 pg/mL and/or bone-specific alkaline phosphatase (BAP) <27 U/L were included in this study and were equally distributed over LCD (1.25 mmol/L) or HCD (1.75 mmol/L) treatment. The duration of the study was 6 months. There was no significant difference in baseline characters and biochemical parameters related to chronic kidney disease-mineral and bone disorder in both the groups. The groups did not differ in the mean tCa before dialysis, but this parameter was significantly lower in the LCD group versus HCD at the end of the study. The mean serum levels of iPTH, total alkaline phosphatase, and BAP in the LCD group were increased at 3 months and at the end of the study compared with the baseline levels. The bone markers in the HCD group did not change significantly. At the end of the study, all bone parameters in the LCD group were significantly higher than in the HCD group. Development of measures indicating increased bone turnover in patients receiving 1.25 mmol/L of dialysate calcium, most likely as a result of inhibiting a positive calcium balance and allowing for long-term PTH secretion stimulation. Hence, LCD might be considered a valuable therapeutic option for ABD patients.
摘要：
近年来,无动力骨病（ABD）已成为成人慢性肾脏病患者常见的骨骼病变。我们旨在比较低钙透析液（LCD）和我们设施的标准钙透析液[高钙透析液（HCD）]对透析患者与ABD相关的骨骼和矿物质参数演变的影响。本研究包括40例透析前完整甲状旁腺激素（iPTH）<100pg/mL和/或骨特异性碱性磷酸酶（BAP）<27U/L的患者，在LCD（1.25mmol/L）或HCD（1.75mmol/L）治疗中分布均匀。研究的持续时间为6个月。两组的基线特征和与慢性肾脏疾病-矿物质和骨骼疾病相关的生化参数没有显着差异。两组透析前的平均tCa没有差异，但在研究结束时，LCD组与HCD组相比，该参数显着降低。iPTH的平均血清水平，总碱性磷酸酶,与基线水平相比，LCD组的BAP在3个月时和研究结束时增加。HCD组的骨标记物没有明显改变。在研究结束时,LCD组的所有骨参数均显着高于HCD组。制定表明接受1.25mmol/L透析液钙的患者骨转换增加的措施，很可能是由于抑制了钙的正平衡并允许长期的PTH分泌刺激。因此，LCD可能被认为是ABD患者的有价值的治疗选择。
