Métabolisme du bilan phosphocalcique dans la maladie rénale chronique : Focus en dialyse péritonéale
DOI :
https://doi.org/10.25796/bdd.v7i3.83573Mots-clés :
dialyse péritonéale, métabolisme phospho-calcique, solution glucosée pauvre en calciumRésumé
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Les patients atteints de MRC ont une anomalie du métabolisme phosphocalcique. Elle se traduit biologiquement par l’apparition d’une hypocalcémie, d’une hyperphosphatémie, d’une hyperparathyroïdie secondaire voire tertiaire et d’une augmentation des phosphatases alcalines totales et osseuses. Les conséquences cliniques sont une augmentation de la morbi mortalité en favorisant notamment les maladies cardiovasculaires et les complications osseuses secondaires aux anomalies du remodelage osseux favorisant le risque fracturaire. Seulement 25 à 50% des patients en dialyse péritonéale ont un bilan phosphocalcique dans les cibles recommandées. Il est essentiel de le corriger. Une attention particulière doit être portée sur le choix de la concentration en calcium des solutions glucosées en tenant compte du contexte clinique et en favorisant les solutions de faible teneur en calcium (concentration à 1,25 mmol/L). Un régime alimentaire et un suivi diététique sont recommandés en première intention avec au besoin des chélateurs de phosphate sans calcium. Le but étant d’éviter l’hypercalcémie et l’hyperphosphatémie. Enfin l’extraction du phosphate est plus importante en DPCA qu’en DPA.
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(c) Tous droits réservés Séverine Beaudreuil 2024
Ce travail est disponible sous la licence Creative Commons Attribution 4.0 International .
