The Study Of Low Calcium Dialysate On Secondary Hypoparathyroidism Of MHD

Objective: To investigate the incidence of secondary hypoparathyroidism in maintenance hemodialysis patients in the 4th hospital of Hebei medical university hemodialysis center,and discuss the possible factors.And study the effect of 1.25mmol/L calcium dialysate on iPTH and calcium-phosphorus metabolism,parathyroid function in the maintenance hemodialysis(MHD)patients with secondary hypoparathyroidism.Methods: MHD patients who are in stable condition over 3 months and no parathyroidectomy were selected,collecting general informationand laboratory test results,analysising patients iTPH distribution and the reasons for secondary hypoparathyroidism.The patients with iPTH<60pg/mL were treated with low-calcium dialysate containing 1.25mmol/L calcium for 6 months,and the changes of serum iPTH,calcium,phosphorus,alkaline phosphatase and other indicators were recorded before and after treatment.Results: 289 MHD patients were selected,with an average iPTH concentration of(177.6±156.1)pg/mL.There were 58 cases(20.1%)with iPTH < 60pg/mL,70 cases(24.2%)with iPTH≥60pg/mL and iPTH < 120pg/mL,34 cases(11.8%)with iPTH≥120pg/mL and iPTH < 150pg/mL,80 cases(27.7%)with iPTH≥150pg/mL and iPTH < 300pg/mL,42 cases(14.5%)with iPTH≥300pg/mL and iPTH < 600pg/mL,and 5cases(1.7%)with iPTH ≥ 600pg/mL.Univariate analysis and multivariate Logistic regression analysis showed that short dialysis duration,low alkaline phosphatase,high serum calcium level,low serum phosphorus level and diabetic nephropathy were risk factors for low iPTH.The 58 patients with low iPTH were treated with low calcium dialysate containing 1.25mmol/L of calcium for 6 months.Compared with pre-treatment,the serum iPTH concentration(110.2±63.6 VS 38.3±13.3)pg/mL,alkaline phosphatase concentration(93.6 ± 26.2 VS 70.9 ± 21.1)IU/L,serum phosphorus concentration(1.84 ± 0.53 VS 1.51 ± 0.49)mmol/L were significantly increased,and serum calcium concentration(2.09±0.17 VS 2.18±0.14)mmol/L were decreased,the differences were statistically significant.Conclusion: Long-term application of Low dialysate calcium concentration(1.25 mmol/L)for hemodialysis can reduce the calcium load of patients and increase the level of iPTH.