Research On Heel Bone Density Related Factors In Maintenance Hemodialysis Patients

Objective: Chronic kidney disease mineral abnormal bone metabolism disorder(CKD-MBD) is the common complications in end-stage renal disease(ESRD) pati ents.maintenance hemodialysis(MHD) patients compared with normal control gr oup have lower bone mineral density(BMD) in previous research.a recent DOPP S study(Study of dialysis patients survival and mode of practice related) also co nfirmed that fracture event rate of MHD patients is high, and has a high mortali ty rate[1].If the related factors of hemodialysis that Prolonged of duration of dial ysis,long-term use of anticoagulants,Differences of dialysis modality,dialysis adeq uacy,Vascular calcification,cardiovascular events and other factors are involved in or participate in MHD patients BMD’S reduction or osteoporosis’ development,t he current research is less At home and abroad.The purpose of this study is to Discuss the related factors affecting BMD of patients with MHD, Especially the clinical factors related to hemodialysis,To further improve the understanding of o steoporosis in MHD patients.It is important to improve the quality of life and lo ng-term prognosis of MHD patients.methods:MHD patients with 459 cases(234cases of male, female 225 cases) are selected From June 2014 to February 2015 in Dalian Central Hospital. MHD patients recorded sex, age, primary disease,duration of dialysis general information; MHD patients recorded blood pressure,differences of dialysis modality, the use of heparin type, cardiovascular events, fr actures events, aortic calcification. Differences of dialysis modality is divided int o a High flux hemodialysis(HFD) and ordinary low dialysis, cardiovascular event s is clinical cardiovascular events,aortic calcification depend on the diagnosis of r adioactive rays; collecting blood biochemical indicators: calcium(Ca), serum ph osphorus(P), serum calcium and phosphorus product(Ca×P), PTH, alkaline phosphatase(ALP), albumin(ALB), hemoglobin(HB), bicarbonate(HCO3-), Kt / v.Using US Hologic Model: Sahara ultrasound BMD instrument for measuring B MD. Analysis of the following aspects: 1.In MHD patients,The differences of B MD about gender, primary disease, duration of dialysis, differences of dialysis m odality, and whether the use of heparin type of hypertension, Whether occur clin ical cardiovascular events, fractures events, aortic calcification; According to the BMD, divided into 3 groups: normal bone mass, bone mass reduction group, ost eoporosis group, that compared the differences of three groups of blood bioche mistry: Ca, P, Ca × P, PTH, ALP, ALB, HB, HCO3-, Kt / v.2. Analysis the co rrelation of MHD patients’ BMD with serum Ca, P, Ca×P, PTH, ALP, ALB, H B, HCO3-, Kt / v,gender, age, primary disease, duration of dialysis, blood press ure,differences of dialysis modality, the use of heparin type, clinical cardiovascul ar events, fractures events, aortic calcification. 3. In the MHD patients, further a nalysis which factors are possible risk factors for osteoporosis.Results:1.The diffe rence between the different clinical factors about BMD: ①.In MHD patients, The female has lower T-score than men(P <0.05), T value was no significant differ ence(P> 0.05)between primary disease for diabetic nephropathy and non diabetic nephropathy, the duration of HD ≤5 years, 5 years <the duration of HD <10years, the duration of HD≥ 10 years,the three groups have no significant diff erence about value of T(P> 0.05); ②.HFD group T value is higher than Ordina ry low HD group with a statistically significant difference(P <0.05),T value was no statistically(P> 0.05)between use of low molecular weight heparin and ordin ary heparin group;③.T value of fracture event group is lower than the group tha t did not occur fracture event(P <0.05),T value of aortic calcification group is lo wer than the group that did not occur aortic calcification(P <0.05),T value has no statistically significant(P> 0.05) between hypertension group and non-hyperten sive group,also for clinical cardiovascular events group and nonclinical cardiovasc ular events group;④ normal bone group and bone mass reduce group ALB, P,Ca×P are higher than osteoporosis group with significant difference(P <0.05),Ca,PTH,ALP,HB and Kt / v are no significant difference(P> 0.05) in the three groups.2.Correlation between bone mineral density and clinical factors in patients with MHD : ①T values has positive correlation with serum P, Ca×P, ALB,R were 0.136,0.101,0.148, no correlation with serum ALP, Ca, KT / V, PTH,HCO3-.②.T values of female, fracture event, ordinary low HD group,aortic ca lcification is low, T values has negatively correlated with age, R =-.379,T val ues have no significant correlation about the use of heparin type,whether occuri ng clinical cardiovascular events,blood pressure(SBP, DBP) and duration of dia lysis.3. Further to analysis the above factors related with BMD regression, inclu ding gender, age, fracture cases, aortic calcification is a risk factor for osteoporo sis in MHD patients.Conclusion: In MHD patients: 1.① women has lower BMD than men; ②BMD of HFD group is higher than normal low dialysis group, b ut there is no differences in the type of heparin; ③ BMD of fracture event gro up is lower than the group that did not occur fracture event,BMD of aortic calci fication group is lower than non-calcified aorta group.④. Serum Phosphorus,calci um-phosphorus product and ALB was significantly lower in osteoporosis. 2.BMD is positively correlated with serum P, Ca×P, ALB,negatively correlated with a ge; 3.fracture event, age, sex, aortic calcification is an independent risk factor for osteoporosis in MHD patients.