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| 만성신부전 환자의 이차성부갑상선 기능항진증에 혈액투석이 미치는 영향 |
| 채종구 , 김만우 , 조건국 |
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| Abstract |
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In the first few weeks after initiation of maintenance hemodialysis in 14 patients with chronic renal failure, there was a progressive rise in total serum calcium associated with a reciprocal and significant fall in the concentration of plasma parathyroid hormone. Studies in 16 additional patients with chronic renal failure already on hemodialysis indicated that this favorable trend did not continue: a progressive rise in parathyroid hormone concentration was associated with increasing duration of hemodialysis against the calcium concentration generally used by most concentration from 2.5 to 3. 5 mEq/l for a 2 months period failed to decrease parathyroid hormone secretion or cause a significant increase in predialysis calcium concentration in 16 uremic patients. Use of high calcium dialysis earlier in the course of the disease, alternate means of parathyroid suppression, subtotal parathyroidectomy may be necessary for the management of hyperparathyroidism in uremic patients undergoing hemodialysis. Following results were obtained 1) The protocol I patients studied prior to the initia- tion of hemodialysis had a mean total serum calcium of 3.91±0.4 mEq/I that rose to 4.35±0.6 mEq/1 after two dialyses and a 3 day interval. After 1 week mean total serum calcium increased to 4. 37±0.5 mEq/l. The significant rise in total serum calcium at 1 and 2 months was accompanied by a reciprocal and significant fall in PTH from a mean concentration of l. 39±0.3~0.74±0.3 ng/ml over the same period. 2) Of the patients studied by Group I, Protocol 2, after 2 months of hemodialysis during which calcium concen- tration in the bath was increase from 2.5 to 3.5 mEq/1, there was no significant change in the 7 patients (Group 2). 3) When mean PTH and length of time on hemodialysis were compared in the same patients, a significant correlation coefficient of 0.54 was demon- strated. |
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