Prevalence Study Of Maintenance Hemodialysis Patients With Mineral And Bone Disorder In Anhui Province

Objective To understand the mineral and bone disorder(MBD) status in the maintenance hemodialysis(MHD) patients in Anhui province; To explore hyperphosphatemia risk factors.Methods To investigate the cases of MHD patients in hemodialysis centers of 26 hospitals, including 19 tertiary hospitals, seven secondary hospitals, of southern, northern and central Anhui province from January 1st,2014 to March 31 st,2014. Research content included general demographic characteristics, laboratory examination, clinical manifestation and medications, etc. Taking KDOQI and KDIGO guidelines as standard respectively, success rate of adjusted serum calcium, phosphorus, intact parathyroid hormone(i PTH) was observed and then compared with the dialysis outcomes and practice patterns study(DOPPS) 3 and DOPPS4; At last, success rate of patients was compared in different hospitals of various grades,who were with MHD adjusted serum calcium, phosphorus, intact parathyroid hormone(i PTH).Results(1) Among the selected 2774 cases, 1662 male, 1112 female, with mean age 52.4 +/- 14.4 years old and the average dialysis time 45.4 +/- 39.1 months, the top three original diseases were chronic glomerulonephritis(49.8%), hypertentensive nephrosclerosis(18.7%) and diabetic nephropathy(15.4%).(2) On the basis of KDOQI guidelines: Anhui MHD patients adjusted serum calcium, serum phosphorus, i PTH success rate was 40.1%, 36.9%, 23.0%, lower than DOPPS 3(50.4%, 49.8%, 31.4%) and DOPPS 4(56.7%, 52.6%, 29.6%)(P<0.01); Compared with the developed areas in China, i PTH success rate is lower(P<0.05)), while adjusted serum calcium and serum phosphorus success rate had no obvious difference(P>0.05).(3) On the basis of KDIGO guidelines, the success rate was 52.0%, 21.6% and 47.8% respectively.(4) Comparing different hospitals of various grades: serum phosphorus and i PTH success rate in tertiary hospital patients was significantly higher than secondary hospitals(P < 0.05), while the adjusted serum calcium success rate has no obvious difference(P>0.05).(5) The treatment situation of MBD: on the basis of KDIGO guidelines, the low serum calcium, hyperphosphatemia and secondary hyperparathyroidism(SHPT) treatment was 53.6%, 53.0% and 68.2% respectively, and inappropriate treatment accounted for 46.4%, 47.0% and 47.0% respectively.(6) Gender, age of dialysis, hemoglobin, region distribution and economic income level had nothing to do with hyperphosphatemia incidence; Overweight, and elevated serum albumin independent were risk factors of hyperphosphatemia; Tertiary hospitals and increasing age were hyperphosphatemia protection factor.Conclusions(1) Anhui MHD patients serum calcium, phosphorus and i PTH success rate are not optimistic. MHD patients in tertiary hospitals with MBD are in more ideal control situation than the basic-level hospitals, thus it indicates that closer monitoring and management are expected to improve the success rate.(2) Independent risk factors with hyperphosphatemia are overweight, elevated serum albumin; Tertiary hospitals and increasing age are hyperphosphatemia protection factors.