Korean Journal of Nephrology 1997;16(1):94-100.
혈액투석 및 복막투석 환자에서 고칼슘혈증의 빈도
김정호 , 이현아 , 정미경 , 이은영 , 차미경 , 송경일 , 박민선 , 한동철 , 황승덕 , 이희발
Abstract
Oral phosphate binders and high calcium dialysate have been used as standard therapies for dialysis patients to prevent renal osteodystrophy. Calcium containing phosphate binders are used to prevent intestinal absorption of dietary phospha@te and to avoid aluminum loading by using aluminum containing phosphate binders. The use of calcium pro- ducts resulted in hypercalcemia in a substantial portion of dialysis population. Calcium carbonate as a phophate binder is widely used in Korea. How- ever, the incidence of hypercalcemia in Korean dia- lysis patients has not been reported to date. In this study we evaluated the incidence of hy- percalcemia in dialysis patients. Patients with asso- ciated diseases that may influence serum calcium level were excluded from the study. A total of 180dialysis patients (116 HD patients and 64 CAPD patients) maintained at Soon Chun Hyang University Hospital were included. Three consecutive 2monthly measurements of serum calcium, phosphate, albumin, alkaline phosphatase, bicarbonate in HD and two consecutive measurements in 3 month interval in CAPD patients were retrospectively evaluated. Ionized calcium and intact parathyroid hormone (N-terminal) were measured every 6 months. Serum total calcium level was corrected by serum albumin level. Three HD patients(2.5%) were hypercalcemic pre- HD while 50(43.1%) hypercalcemic postdialysis. 5 CAPD patients(7.8%) were hypercalcemic. Pre-HD calcium level did not differ from the value in CAPD patients. An average value of pre-and post- HD calcium, and serum albumin levels were signi- ficantly higher in HD patients than those values in CAPD patients(p<0.01). Ionized calcium (p<0.01) and serum PTH(p<0.05) levels were significantly higher, while serum bicarbonate level (p<0.01) was significantly lower in HD patients than in CAPD patients. The amount of calcium carbonate used were 2.2g In HD and 2.8g in CAPD. In conclusion, the incidence of hypercalcemia is low in pre-HD (2.5%) and in CAPD patients(7.8%). However, the high incidence of post-HD hyper- calcemia observed in this study advocates a future study to evaluate the effect of low calcium dialyste on calciumnhosuhate metabolism.
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