Objective: To research the influence of peritoneal dialysis (PD) and hemodialysis(HD) on calcium phosphorus dysmetabolism in patients with end-stage renal disease. Methods: All patients were divided into peritoneal dialysis group (PD group) and hemodialysis group (HD group), and each 18 cases. The follow up duration was 12 months. By specific immunometric assays, serum levels of intact parathyroid hormone (iPTH) were measured. Serum biochemical parameters in cluding alkaline phosphatase (ALP), albumin (ALB), calcium (Ca), phosphorus (P) and calcium phosphorus product (Ca xP) were also monitored and measured. Active vitamin D3 and calcium carbonate doses, as well as the patients complaints and clinical events related to the therapeutic regimen were recorded on the whole course of the follow-up. Results: In the PD group, after 12 months observation, serum levels of P, iPTH and Ca xP decreased significantly (all P<0.05). While as the dosages of calcium carbonate and vitamin D3 increased, the incidence of hypercalcaemia was significant higher in HD group than in the PD group (all P<0.05). Conclusion: The tolerance of the treatment of calcium carbonate and vitamin D3 in PD is better than that in HD. Continuous ambulatory peritoneal dialysis (CAPD) is associated with improved serum mark ers of mineral metabolism and increased tolerance for calcium-based phosphate binders and active vitamin D3. The mechanism is still remained further investigation.%目的:研究血液透析和腹膜透析对终末期肾病透析患者钙磷代谢紊乱及治疗的影响.方法:前瞻性随访对照研究,腹膜透析和血液透析病例各18例,按K/DOQI指南建议在适当控制饮食基础上使用碳酸钙控制血磷水平,同时根据患者血钙、血磷、钙磷乘积以及血清甲状旁腺素水平按K/DOQI推荐和药物应用指南应用活性维生素D3治疗继发性甲状旁腺功能亢进症,随访12个月,比较血液透析与腹膜透析患者钙磷代谢紊乱治疗及疗效的差异.结果:经过12个月的随访治疗,与治疗前比较,腹膜透析患者血磷水平、钙磷乘积及血清甲状旁腺激素水平显著下降(均P<0.05),在碳酸钙及活性维生素D3的应用剂量显著增加的同时,腹膜透析组患者高钙血症发生率较血液透析组患者低(均P<0.05).结论:腹膜透析患者较血液透析患者对碳酸钙和(或)活性维生素D3治疗的耐受性好,在钙磷代谢紊乱控制及继发性甲状旁腺功能亢进的治疗上存在明显的优势,但其机制尚有待进一步观察研究.
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