老年维持性血液透析病人血镁水平及其临床意义

doi:10.3969/j.issn.1003-9198.2023.12.005

摘要/Abstract

摘要： 目的调查老年维持性血液透析(maintenance hemodialysis,MHD)病人血镁水平,分析不同血镁水平病人的血压、全段甲状旁腺激素(intact parathyroid hormone, iPTH)水平及营养状况。方法选择99例透析充分的老年MHD病人,根据透析前血镁水平将病人分为低镁组(＜0.75 mmol/L,n=24)、正常组(0.75～1.02 mmol/L,n=45)和高镁组(＞1.02 mmol/L,n=30),比较3组透析前血钙、血磷、iPTH、血浆白蛋白、Hb的水平以及透析中和透析间期的血压。结果不同血镁水平病人透析间期血压无明显变化,低镁组透析中SBP明显低于正常组和高镁组(P<0.01),DBP明显低于正常组(P<0.01)。3组间血iPTH、血钙、血磷、Hb水平按低镁组、高镁组、正常组依次升高,且3组间差异均有统计学意义(均P <0.01);正常组血浆白蛋白和Hb水平明显高于低镁组(P <0.05)。结论老年MHD病人血镁水平正常或升高者通常营养指标较好,透析中血压相对稳定,同时iPTH水平偏高。
【关键词】维持性血液透析; 血镁; 全段甲状旁腺激素; 血压; 营养状况

关键词: 维持性血液透析, 血镁, 全段甲状旁腺激素, 血压, 营养状况

Abstract: Objective To investigate the blood magnesium levels of the elderly patients undergoing maintenance hemodialysis (MHD), and to analyze the levels of blood pressure, intact parathyroid hormone (iPTH) and nutritional status in the patients with different levels of blood magnesium. Methods A total of 99 elderly MHD patients were enrolled and divided into low-magnesium group (＜0.75 mmol/L, n=24), normal-magnesium group(0.75-1.02 mmol/L, n=45) and high-magnesium group (＞1.02 mmol/L, n=30) according to the level of blood magnesium before hemodialysis. The levels of calcium, phosphorus, iPTH, plasma albumin, hemoglobin before hemodialysis and the blood pressure during hemodialysis and hemodialysis interval were observed and compared among the three groups. Results There was no significant difference in interdialytic blood pressure among the groups with different magnesium levels. The systolic blood pressure in the low-magnesium group was significantly lower than that in the normal-magnesium group and high-magnesium group (P<0.01), and the diastolic blood pressure in the low-magnesium group was significantly lower than that in the normal-magnesium group (P<0.01). The levels of iPTH, calcium, phosphorus and hemoglobin were significantly increased in the low-magnesium group, followed by the normal-magnesium group and the high-magnesium group (P<0.01). The plasma albumin level in the normal-magnesium group was significantly higher than that in the low-magnesium group (P<0.05). Conclusions Elderly MHD patients with normal or elevated blood magnesium levels usually have relatively normal nutritional status, relatively stable blood pressure and high level of iPTH during dialysis.

Key words: maintenance hemodialysis, serum magnesium, intact parathyroid hormone, blood pressure, nutritional status

中图分类号:

R 692

刘虹伶, 王暴魁, 雷洁, 刘钰, 李苏童. 老年维持性血液透析病人血镁水平及其临床意义[J]. 实用老年医学, 2023, 37(12): 1206-1209.

LIU Hong-ling, WANG Bao-kui, LEI Jie, LIU Yu, LI Su-tong. Clinical value of blood magnesium levels in elderly patients with maintenance hemodialysis[J]. Practical Geriatrics, 2023, 37(12): 1206-1209.

参考文献

[1] MASSY Z A, NISTOR I, APETRII M, et al. Magnesium-based interventions for normal kidney function and chronic kidney disease[J]. Magnes Res, 2016, 29(4): 126-140.
[2] PERIDE I, TIGLIS M, NEAGU T P, et al. Magnesium-A more important role in CKD-MBD than we thought[J]. Diagnostics, 2022, 12(4): 880.
[3] HAN Z, ZHOU L, LIU R, et al. The effect of hemodialysis on serum magnesium concentration in hemodialysis patients[J]. Ann Palliat Med, 2020, 9(3): 1134-1143.
[4] MACÍAS RUIZ M D C, CUENCA BERMEJO L, VERONESE N, et al. Magnesium in kidney function and disease-Implications for aging and sex-A narrative review[J]. Nutrients, 2023, 15(7): 1710.
[5] OKA T, HAMANO T, SAKAGUCHI Y, et al. Proteinuria-associated renal magnesium wasting leads to hypomagnesemia: a common electrolyte abnormality in chronic kidney disease[J]. Nephrol Dial Transplant, 2019, 34(7): 1154-1162.
[6] DAVENPORT A. Why is intradialytic hypotension the commonest complication of outpatient dialysis treatments?[J]. Kidney Int Rep, 2023, 8(3): 405-418.
[7] POWER A, BROWN E. Optimising treatment of end-stage renal disease in the elderly[J]. Nephron Clin Pract, 2013, 124(3/4): 202-208.
[8] TANGVORAPHONKCHAI K, DAVENPORT A. Magnesium and cardiovascular disease[J]. Adv Chronic Kidney Dis, 2018, 25(3): 251-260.
[9] KYRIAZIS J, KALOGEROPOULOU K, BILIRAKIS L, et al. Dialysate magnesium level and blood pressure[J]. Kidney Int, 2004, 66(3): 1221-1231.
[10] 王树祥, 马洪波, 路群, 等. 维持性血液透析慢性肾衰竭患者血镁与低血压事件的关系[J]. 山东医药, 2009, 49(41): 82-83.
[11] 黄荣强, 纪坤伦, 韦秋萍, 等. 维持性血液透析患者继发性甲状旁腺功能亢进外科治疗的研究进展[J]. 齐齐哈尔医学院学报, 2022, 43(14): 1366-1370.
[12] BRESSENDORFF I, HANSEN D, SCHOU M, et al. The effect of increasing dialysate magnesium on serum calcification propensity in subjects with end stage kidney disease[J]. Clin J Am Soc Nephrol: CJASN, 2018, 13(9): 1373-1380.
[13] 李娟, 曹玉涵, 汪正翔, 等. 血液透析患者血清镁离子浓度与全段甲状旁腺激素水平及预后的相关性[J]. 皖南医学院学报, 2021, 40(3): 221-224.
[14] FOOLADGAR M, MALEKPOUR A, ASGARI-SAVADJANI S, et al. Serum magnesium in association with parathyroid hormone levels in routine hemodialysis patients[J]. J Parathyroid Dis, 2017, 6(1): 13-15.
[15] SHAMSPOUR N, MOLAHOSEINI M, AZMANDIAN J, et al. To evaluate the relationship between serum magnesium and parathyroid hormone levels in peritoneal dialysis and hemodialysis patients[J]. Inter Urol Nephrol, 2023, 55(5): 1321-1327.
[16] LI L, STREJA E, RHEE C M, et al. Hypomagnesemia and mortality in incident hemodialysis patients[J]. Am J Kidney Dis, 2015, 66(6): 1047-1055.
[17] LACSON E, WANG W, MA L, et al. Serum magnesium and mortality in hemodialysis patients in the United States: a cohort study[J]. Am J Kidney Dise, 2015, 66(6): 1056-1066.
[18] VETTER T, LOHSE M J. Magnesium and the parathyroid[J]. Curr Opin Nephrol Hypertens, 2002, 11(4): 403.
[19] RODRÍGUEZ-ORTIZ M E, CANALEJO A, HERENCIA C, et al. Magnesium modulates parathyroid hormone secretion and upregulates parathyroid receptor expression at moderately low calcium concentration[J]. Nephrol Dial Transplant, 2014, 29(2): 282-289.
[20] 王嘉, 吴斌. 糖尿病肾病患者维持性血液透析中镁代谢紊乱及冠状动脉钙化的影响因素[J]. 中国卫生工程学, 2021, 20(1): 155-156,159.
[21] 林莹莹, 汪年松, 尹建永, 等. 血液透析患者血镁水平与死亡的相关分析[J]. 医学研究杂志, 2021, 50(3): 31-35.