ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2023, Vol. 32 ›› Issue (3): 281-285.DOI: 10.3969/j.issn.1006-298X.2023.03.017

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重视终末期肾病血液透析患者血镁的变化

  

  • 出版日期:2023-06-28 发布日期:2023-07-01

Attention should be paid to magnesium in hemodialysis patients with end-stage kidney disease

  • Online:2023-06-28 Published:2023-07-01

摘要: 镁是机体具有重要生理、生化作用的离子,终末期肾病血液透析(HD)患者的血镁受到残余肾功能、透析清除率、药物和营养状况等因素的影响。高镁血症常见但很少伴随临床症状,低镁血症与HD患者的透析中低血压、心律失常、肌肉痉挛以及心血管死亡率和全因死亡率的增加相关。轻度的高镁血症可在一定程度上改善HD患者的甲状旁腺素水平、血管钙化和骨健康。质子泵抑制剂、大剂量袢利尿剂和营养不良可降低血镁浓度,使用较高镁浓度的透析液予以补充安全简便。镁与HD患者的生存状况和预后有关,虽然目前尚不清楚镁与透析患者临床结局之间是否存在因果关系,略高于生理水平的镁似乎更能使患者获益。故有必要对HD患者的镁代谢进行深入研究,以探索是否存在最佳的血镁范围,使患者的骨健康、心血管结局和生存率得到优化。


关键词: 终末期肾病, 低镁血症, 血液透析, 透析液, 慢性肾脏病矿物质与骨异常

Abstract: Magnesium is an ion with important physiological and biochemical effects. The serum magnesium of hemodialysis patients with endstage kidney disease is affected by residual renal function, dialysis clearance, drug and nutritional status.Hypermagnesemia is common but rarely accompanied by clinical symptoms,well hypomagnesemia is associated with increased hypotension, arrhythmia, muscle spasm, cardiovascular mortality, and all-cause mortality in hemodialysis patients. Mild hypermagnesemia can improve the parathyroid hormone level, vascular calcification and bone health of hemodialysis patients to a certain extent. Proton pump inhibitors, high-dose loop diuretics and malnutrition can reduce the serum magnesium concentration. It is safe and convenient to use dialysate with higher magnesium concentration to supplement. Magnesium is related to the survival status and prognosis of dialysis patients. Although it is not clear whether the relationship between magnesium and the clinical outcome of dialysis patients is causal, serum magnesium slightly higher than the physiological level seems to benefit patients more. It is necessary to further study metabalism of magnesium in hemodialysis patients to explore whether there is an optimal range of serum magnesium, so as to optimize the bone health, cardiovascular outcomes and survival rate of patients.


Key words: end-stage kidney disease, hypomagnesemia, hemodialysis, dialysate, chronic kidney disease-mineral bone disorder