透析病人腎性骨病變之鈣、磷控制的重要性及方法

The Control of Calcium and Potassium in Dialysis Patients

腎衰竭會影響骨組織的代謝造成腎性骨病變，是透析病人的主要併發症之一，也是評估透析品質的重要指標。而這種骨組織的代謝異常大致可分成高週轉率和低週轉率骨病變，前者是次發性副甲狀腺亢進引起而後者可因鋁骨病變和骨生成不良造成。腎性骨病變的預防及控制，磷、鈣在其中佔有重要的角色，經由血磷和血鈣的濃度的調整以便達到控制副甲狀腺功能亢進及避免低週轉率骨病變。

Renal osteodystrophy, a well-established chronic complication of dialysis patients and also a surrogate for quality of renal replacement therapy, is classified into high-turnover and low-turnover rate bone diseases. The former is mainly caused by secondary hyperparathyroidism, whereas the latter consists of aluminum intoxication and adynamic bone disease. According to the pathophysiology of renal osteodystrophy, manipulation of serum calcium and phosphate is critical for the management of dialysis patients to prevent and control this complication. The goal of management of renal osteodystrophy is not only to get good control of hyperparathyroidism, but also to avoid low-turnover rate bone diseases.