| Objectives: To investigate the control rate of mineral metabolism in peritoneal dialysis patients(PD)and its associated factors.We also assessed the impact of consistent control of calcium(Ca),phosphorus(P)and parathyroid hormone(PTH),within the KDIGO target ranges on important clinical outcomes in incident PD patients.Methods: 1.ESRD patients who underwent PD for more than 3 months,older than 18 years with complete data and started on PD between 1 January 2000 and 31 October 2013 in Renji Hospital,Shanghai Jiao Tong University School of Medicine were enrolled in this study.All patients were followed up from the date of PD initiation until death,cessation of PD,transfer to other centers,loss to follow-up or to the end of the study(October 31,2015).The control rates of mineral metabolism were evaluated based on KDIGO target ranges.Multiple regressions were used to analyze the associated factors of mineral metabolism.Patients were grouped according to their control of Ca,P and i PTH.Survival probabilities were studied with Kaplan-Meier method and compared by the log-rank test,multivariate Cox proportional hazards models were applied to assess the association of control of Ca,P and i PTH with all-cause mortality and CVD mortality.Results: A total of 738 PD patients were enrolled in present study.Among them,353(47.8%)were males with mean age of 54.9±15.5 years.173(23.4%)patients had diabetes and 182(24.7%)had CVD.1.The control rates of Ca,P,Ca-P product and i PTH were 70.1%,64.7%,87.6% and 47.3% respectively.After PD initiation,the control rate of Ca was significantly higher(70.1% vs 52.4%,P<0.001)than that of predialysis;the control rate of P was also significantly increased((64.7% vs 17.2%,P<0.001))but decreased with the extension of dialysis duration;the control rate of PTH was decreased(47.3% vs 62.2%,P<0.001)after PD start and the proportion of patients with low i PTH was increased.2.Phosphorus level in the early stage of PD was independently associated with serum albumin(r=0.208,P<0.001),Kt/V(r=-0.099,P=0.037)and hemoglobin(r=-0.1888,P<0.001),and after 12 months on PD,the RRF(r=-0.327,P<0.001),n PCR(r=0.184,P<0.001),i PTH(r=0.114,P=0.025)and alkaline phosphatase(r=-0.140,P=0.025)become the associated factors.i PTH level was associated with serum calcium(r=-0.294,P<0.001),alkaline phosphatase(r=0.125,P=0.006)and serum albumin(r=0.097,P=0.033)in the initial phase of PD,and after 12 months on dialysis,alkaline phosphatase(r=0.346,P<0.001),and phosphorus(r=0.100,P=0.037)acted as independent associated factors.3.Achieving all three mineral metabolism parameters(Ca,P and i PTH)target levels in the baseline was closely related to the long-term survival in PD patients(HR 1.699,95%CI 1.043~1.066,p=0.022).Compared to patients on target for three mineral metabolism parameters at least once during the follow-up,patients not reaching all three mineral metabolism parameters had worse survival(Log rank 11.469,p=0.001),and increased CVD mortality(Log rank 6.252,p=0.012).Never achieved all three mineral metabolism parameters during the follow-up was an independent predictor for all cause mortality(HR 1.542,95%CI 1.136~2.094,p=0.006)and CVD mortality(HR 1.542,95%CI 1.136~2.094,p=0.006).Conclusions: 1.Compared to predialysis the control rate of calcium,phosphorus and calcium-phosphorus product were significantly increased,in PD patients,except for parathyroid hormone which was decreased after dialysis.But the overall control rate is still unsatisfied.2.Calcium,phosphorus and parathyroid hormone were interrelated,phosphorus level was associated with Kt/v,RRF and dietary protein intake.i PTH level was associated with serum calcium,serum phosphorus,serum albumin and alkaline phosphatase.3.Achieving all three mineral metabolism parameters(Ca,P and i PTH)target levels in the baseline was closely related to the long-term survival in PD patients.Never achieved all three mineral metabolism parameters during the follow-up was an independent predictor for all cause mortality and CVD mortality... |
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