Clinical Study of Three Different Modes of Blood Purification for Clearance of Serum Phosphate in Maintenance Hemodialysis Patients_West China Medical Journal

Authors：

PU Chao , CHEN Yongzhong , BAI Jianing , ZHU Zaizhi ,  XU Zhizhong.

Department of Nephrology, People’s Hospital of Meishan City, Meishan, Sichuan 620010, P. R. China;

Corresponding author：

XU Zhizhong., Email: leshanmcliu@163.com

Keywords：

血液透析; 血液灌流; 血液透析滤过; 高磷血症

DOI：

10.7507/1002-0179.20130159

Video：

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目的　观察三种不同血液净化方式[血液透析（HD）、血液透析滤过（HDF）、血液透析+血液灌流（HD+HP）]对维持性血液透析患者高磷血症清除效果。方法　选择2009年2月－2011年2月行维持性血液透析的48例高磷血症患者为研究对象，所有患者在低钙透析（1.25 mmol/L）的基础，随机分为HD组、HDF组、HD+HP组，每组16例，分别在治疗时及治疗后4周、8周检查钙、磷、钙磷乘积和全段甲状旁腺激素，并观察其变化。结果　在治疗4周、8周后，HDF组、HD+HP组磷较前均显著下降（P值均＜0.05），两组同时点相比较差异无统计学意义（P＞0.05）；HD组较前血磷无明显变化（P＞0.05）。结论　HDF、HP清除维持性血液透析患者高磷有显著的效果，而HD效果则不佳。

Citation： PU Chao,CHEN Yongzhong,BAI Jianing,ZHU Zaizhi,XU Zhizhong.. Clinical Study of Three Different Modes of Blood Purification for Clearance of Serum Phosphate in Maintenance Hemodialysis Patients. West China Medical Journal, 2013, 28(4): 495-498. doi: 10.7507/1002-0179.20130159 Copy

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6.	Sprague SM, Abboud H, Qin P, et al. Lanthanum carbonate reduces phosphorus burder in patients with CKD stage 3 and 4: a randomized trial[J]. Clin J Am Soc Nephrol, 2009, 4(1): 178-185.
7.	尹道馨，张东亮，刘文虎. 血液透析滤过在维持性透析患者中的临床应用[J].首都医科大学学报，2009, 30(2): 154-160.
8.	Davenport A, Gardner C, Delaney M, et al. The effect of dialysis modality on phosphate control: haemodialysis compared to haemodiafiltration. The Pan Thames Renal Audit[J]. Nephrol Dial Transplant, 2010, 25(3): 897-901.
9.	王秀玲, 刘健, 桑小红, 等．HA型大孔树脂血液灌流治疗慢性肾功能衰竭的临床观察[J]. 中华肾脏病杂志, 2000, 16(2): 97-99.
10.	唐万欣，陶冶，付平，等. 连续性静脉-静脉血液滤过中低磷血症防治及危重评分相关性研究[J]. 华西医学, 2007, 22(1): 40-41.
11.	张景红, 宦红娣. 维持性血液透析患者高磷血症的控制[J]. 中国血液净化, 2009, 8(10): 533-535.
12.	李海明, 顾勇, 薛骏，等. 甲状旁腺全切除加前臂移植治疗尿毒症继发性甲状旁腺功能亢进[J]. 中华肾脏病杂志, 2006,22(4): 197-200.

1. 　Melamed ML, Eustace JA, Plantinga L, et al. Changes in serum cal-cium, phosphate, and PTH and the risk of death in incident dialysis patients: a longitudinal study[J]. Kidney Int, 2006, 70(2): 351-357.
2. 　张建荣，张凌. 慢性肾脏病继发性甲旁亢[M]. 北京: 人民军医出版社，2010: 85-92.
3. 　Palmer SC, Hayen A, Macaskill P, et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis[J]. JAMA, 2011, 305(11): 1119-1127.
4. 　张凌. 重视慢性肾衰竭患者高磷血症的处理[J]. 中国血液净化，2004，3 (4)：181-183.
5. 　Block GA, Spiegel DM, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to henodialysis[J]. Kidney Int, 2005, 68(4): 1815-1824.
6. 　Sprague SM, Abboud H, Qin P, et al. Lanthanum carbonate reduces phosphorus burder in patients with CKD stage 3 and 4: a randomized trial[J]. Clin J Am Soc Nephrol, 2009, 4(1): 178-185.
7. 　尹道馨，张东亮，刘文虎. 血液透析滤过在维持性透析患者中的临床应用[J].首都医科大学学报，2009, 30(2): 154-160.
8. 　Davenport A, Gardner C, Delaney M, et al. The effect of dialysis modality on phosphate control: haemodialysis compared to haemodiafiltration. The Pan Thames Renal Audit[J]. Nephrol Dial Transplant, 2010, 25(3): 897-901.
9. 　王秀玲, 刘健, 桑小红, 等．HA型大孔树脂血液灌流治疗慢性肾功能衰竭的临床观察[J]. 中华肾脏病杂志, 2000, 16(2): 97-99.
10. 　唐万欣，陶冶，付平，等. 连续性静脉-静脉血液滤过中低磷血症防治及危重评分相关性研究[J]. 华西医学, 2007, 22(1): 40-41.
11. 　张景红, 宦红娣. 维持性血液透析患者高磷血症的控制[J]. 中国血液净化, 2009, 8(10): 533-535.
12. 　李海明, 顾勇, 薛骏，等. 甲状旁腺全切除加前臂移植治疗尿毒症继发性甲状旁腺功能亢进[J]. 中华肾脏病杂志, 2006,22(4): 197-200.

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Clinical Study of Three Different Modes of Blood Purification for Clearance of Serum Phosphate in Maintenance Hemodialysis Patients

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