Analysis Of Related Factors Of Peritoneal Dialysis Patients With Anemia

Objective With the increasing incidence of end-stage renal disease(ESRD),the population of kidney replacement therapy has gradually expanded.China has been developing peritoneal dialysis technology for more than 30 years.Currently,more than 40,000 patients are being treated with PD,accounting for about 20% of the total dialysis population.Studies have shown that China is one of the fastest growing countries in the world for PD patients.Although PD is currently developing rapidly,due to the absence of vascular access loss in patients with PD,clinical anemia is often less concerned with anemia than with hemodialysis(HD)patients.Anemia in PD patients should not be underestimated.Renal anemia is one of the common complications in ESRD patients.With the decline of renal function,the incidence of anemia gradually increases,and the degree of anemia gradually increases.According to the current survey of the prevalence of anemia in Chinese CKD patients,the incidence of anemia in non-dialyzed CKD patients is 51.5%,of which the incidence of CKD stage 5 of anemia is more than 90%,and 98.2% of CKD patients enter dialysis.If anemia is not corrected timely,anemia can cause a series of serious problems.Anemia can accelerate the progress of CKD,and increase the hospitalization rate and the risk of death,and significantly affect the quality of life of CKD patients.It is also an independent risk factor for cardiovascular disease in CKD patients.Therefore,the treatment of anemia is very important.However,the current rate of anemia is not ideal.The study analyzed the anemia status of PD patients by analyzing the regularity of PD patients in the Department of Nephrology of the First Affiliated Hospital of Anhui Medical University,and analyzes the relevant risk factors for them.The treatment of renal anemia provides new diagnostic ideas.Objects and Methods1.Patients A total of 186 patients who were followed up for PD within one year after the new peritoneal dialysis catheterization in our center were selected between March 2011 and June 2017,all of which met the inclusion and exclusion criteria.2.Method(1)Collect general clinical data of patients,such as gender,age,height,weight,blood pressure,whether combined with cardiac insufficiency,primary disease,etc.,and calculate body mass index(BMI);(2)Collect laboratory data of patients,and use automatic biochemical detection equipment to measure blood calcium,blood phosphorus,serum albumin,parathyroid hormone,C-reactive protein,blood lipid,iron metabolism and other indicators;(3)Collect relevant data on peritoneal dialysis adequacy and transport characteristics of patients undergoing peritoneal dialysis,and calculate Kt / V,total Ccr,PET classification and other indicators;(4)Collecting iron metabolism indexes of patients,calculating transferrin saturation and ferritin compliance rate in 186 PD patients;(5)Group according to age to compare the incidence of anemia in different age groups;(6)Group according to age to compare the incidence of anemia in different age groups;(7)The proportion of primary disease,distribution of hemoglobin,and the incidence of anemia in different age groups were analyzed in 186 PD patients.According to the hemoglobin target in the KDIGO guidelines,patients were divided into control group(Hb?110g / L)and anemia group(Hb <110g / L).Comparison of general information and laboratory indicators between the anemia group and the control group,Pearson correlation was used to analyze the influencing factors of anemia in PD patients.With or without anemia as the dependent variable,the relevant variables were selected into the model for Logistic regression analysis.Results(1)General information of patients and proportion of primary disease: 186 PD patients were selected in this study,including 82 males(44.09%),104 females(55.91),average age(46.2 ± 13.4)years,and average hemoglobin 97.59 g / L.Among the 186 PD patients,88 were chronic glomerulonephritis,accounting for 47.3%,which is the highest proportion of all primary diseases,and 9 cases of diabetic nephropathy,accounting for only 4.8%;(2)Distribution of hemoglobin: The average hemoglobin of 186 PD patients was97.59 g / L,and the incidence of anemia in our center was 68.3%.Among all patients,hemoglobin group in the range of 90-110 g / Lwas the largest,accounting for 31.2%;(3)Comparison of general information and laboratory indicators between the anemia group and the control group: serum creatinineand soluble transferring significantly higher than the control group,while serum albumin was significantly lower than the control group,the difference statistically significant(P<0.05);There were no significant differences in the two groups in Gender,age,body mass index,blood pressure,uric acid,blood calcium,blood phosphorus,parathyroid hormone,blood lipid,C-reactive protein,combined cardiac insufficiency,etc.(4)The incidence of anemia in different age groups:Comparing the incidence and proportion of anemia in three groups of patients in different age groups,the results suggest that among the 186 patients,the number of patients in the young group is more,but the incidence of anemia is highest in the middle-aged group,which is significantly higher than the overall incidence of anemia.Chi-square test was used to compare the difference between the three groups,and indicating no significant difference in the incidence of anemia between different age groups;(5)Iron metabolism status in PD patients: The center collected data on iron metabolism related indicators of 186 patients with regular peritoneal dialysis.The rate of compliance of transferrin saturation was 68.3% and the rate of compliance of ferritin was 62.4%.The difference analysis of iron metabolism indexes between the two groups showed that there were statistically significant differences in soluble transferrin receptor indicators,but there were no significant difference in serum iron,transferrin,ferritin,and total iron binding capacity.(6)Comparison of dialysis evaluation indicators: This article analyzes 95 patients with complete dialysis evaluation data.The total Ccr is divided into the group of total Ccr <50 L/wk/1.73 ? and the groups of total Ccr?50 L/wk/1.73 ?,and the total Kt /V is divided into total Kt / V <1.7 groupsand total Kt / V?1.7groups.Analysis of the differences between the two groups,the results showed that there were no significant difference in PD adequacy index and peritoneal equilibration test;(7)Analysis of related factors of anemia in PD patients: Pearson correlation analysis showed: There is a positive correlation between hemoglobin and serum albumin,and a negative correlation with serum creatinine,p<0.05,the difference is statistically significant.Multivariate Logistic Regression Analysis of PD Patients with Anemia:the two variablesserum albumin and serum creatininewere incorporated into the logistic regression analysis model,Multivariate Logistic regression analysis results suggest that serum creatinine(OR = 1.002,95% CI 1.001-1.004)and serum albumin(OR = 0.875,95% CI 0.815-0.940)are independent risk factors affecting PD patients with anemia.Conclusion1.This study found that hypoproteinemia is an independent risk factor for anemia in patients with peritoneal dialysis.Care should be taken to strengthen the nutritional support of CKD patients,especially dialysis patients,so as to improve the prognosis of anemia patients.2.This study indicates that serum creatinine is an independent risk factor for PD patients with anemia.The serum creatinine level may indirectly reflect the adequacy of dialysis.Therefore,the adequacy of peritoneal dialysis in PD patients should be regularly evaluated,which is beneficial to the improvement of anemia.