長期血液透析患者の臨床的検討 第3編: 長期血液透析患者のカルシウム代謝障害について

Abstract

Ninety-eight patients have been treated by regular dialysis during 10 years period, 1968 to 1977. In order to prevent hyperphosphatemia, phosphate-binding antiacid drug has been administered and calciunl content of dialysate (Dca) was increased from 5 to 7.5mg%. C-terminal PTH value showed as twice as normal but N-terminal PTH was normal when Dca was 5 mg%. Immediately after Dca was changed to 7 mg%, N-terminal PTH transiently rose and soon returned to normal value. C-terminal PTE showed remarkable decrease returning to the normal range. CT was always normal despite change of Dca. Vitamin D3 and 25-HCC level were normal, 24, 25-DHCC was low, and I, 25-DHCC was also low in hemodialysis cases. These substances were almost undetectable in anephric cases. Cortical thickness of the clavicula of the patients did not show a significant difference from that of the healthy control persons. MCl also did not show any change during the course of dialysis. If limited to 20 cases who have been treated by hemodialysis more than 5 years, bone x-ray films showed osteal resorption in 6, demineralization in 4, osteosclerosis in 1. Neither fracture nor vascular calcification was observed. As mentioned above, calciunl metabolism has been rather well controlled under our dialysis program in which BUN and creatinine were maintained at the relatively low level by dialysis performed for sufficient time. Causative factors of calcium metabolism disorder might be metabolic disturbance of vitamin D and phosphate retention. A participation of some kind of uremic toxins should be also considered.