지속성 외래 복막 투석 환자에서 고칼슘혈증의 위험인자에 관한 연구

Abstract

Hyperphosphatemia is a major problem in develo- ping secondary hyperparathyroidism and renal osteodystrophy in patients with end-stage renal failure. To control hyperphosphatemia, calcium car- bonate(CaCC4) has been widely used but its use is limited by the development of hypercalcemia. We evaluated the incidence of hypercalcemia in 173 CAPD patients on CaCOz therapy and compared some parameters to identify the risk factors for the development of hypercalcemia between 22 hyper- calcemic patients(more than 2 episodes of corrected serum calcium>10.5mg/dL or elevation of serum calcium more than 1.0mg/dL compared with baseline serum calcium level) and 22 eucalcemic patients matched for age, sex and duration of dialysis. Forty of 173 patients(23.1%) experienced hypercalcemia and serum calcium level was normalized in all patients after discontinue CaCOz, but readministration of CaCC4 made 11 patients(27.5%) hypercalcemic again. Hypercalcemic patients had significantly higher serum calcium level than eucalcemic patients(9.8±0.3 vs 9.1 ±0.4mg/dL, p<0.05), but the serum phosphate levels were similar in both groups(4.5+0.8 vs 4.3+0.8mg/ dL). Hypercalcemic patients had significantly lower levels of serum alkaline phosphatase(51.3±19.5 vs 71.9±25.7IU/L, p<0.05) and iPTH(77.0±132.0 vs 280.6±390.0pg/ml, p<0.05) compared with eucalce- mic group. But there was no difference in serum aluminum level between the groups. Other biochemi- cal parameters including total protein, albumin and total cholesterol, peritoneal transport characteristics assessed by PET, nutritional status by SGA, an- thropometric data and dialysis dose by urea kinetic modelling were similar in both groups. The patients with relatively low iPTH level(<150pg/ml) had higher serum calcium level(9.2±0.7 vs 8.8±0.8mg/ dL) than that in patients with relatively higher iPTH level(>=150pg/ml), and there were more patients who experienced hypercalcemia(47.1 vs 10.3%) in low iPTH patients. In conclusion, hypercalcemia seems to de- velop more frequently in patients with low turnover bone disease showmg low alkaline phosphatase and iPTH levels, and dialysate with low calcium content should be considered for use in these patients.