| Objective: To understand the status of mineral and bone metabolism in patients with Chronic Kidney Disease(CKD)stage 3-5.To analyze the control compliance rate of calcium,phosphorus and Intact Parathormone(iPTH).And the associations between nutrition indexes,magnesium,Carotid intima-media(Carotid Intimal Media Thickness,IMT)thickening,abdominal aortic calcification and above-mentioned indexes.And thereby provide theoretical basis for accurate management of mineral and bone metabolism,and slows down the complications of CKD patients.Methods: To collect the patient’s height,weight,calculate BMI,blood pressure,hemoglobin,calcium,phosphorus,magnesium,alkaline phosphatase(ALP),blood urea,creatinine,uric acid,cystatin C,albumin,prealbumin,total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL),iPTH,25-(OH)D,carotid intima-media thickness(IMT),abdominal aorta calcification,history of hypertension and diabetes of 145 patients departmented by Handan First hospital through the hospital management system.With simplified MDRD formula Estimated Glomerular Filtration Rate(eGFR).To calculate the rate of compliance of calcium,phosphorus and iPTH.To analyze the associations between calcium,phosphorus and iPTH and the above nutritional indicators(BMI,lipid profile,albumin,prealbumin),magnesium,IMT and vascular calcification.Results:1.In 145 patients with CKD,the serum calcium was 2.088±0.020mmol/L,phosphorus was 1.844±0.049mmol/L,iPTH was 283.296±18.781pg/mL,creatinine was652.490±27.968umol/L.Hypocalcemia is 35(24.138%),hypercalcemia is 22(15.172%),hyperphosphatemia is 103(71.034%),and SHPT is 68 cases(46.897%).2.The serum calcium of patients with CKD3-5 were 2.311±0.023,2.277±0.021,2.175±0.021mmol/L;serum phosphorus were 1.278±0.085,1.367±0.082,1.968±0.053mmol/L;and iPTH were 138.627±25.397,168.397±24.826,262.40(234.00)pg/mL.The comparison showed that there was no significant difference in calcium levels between CKD3 and CKD4,while the serum calcium level in CKD5 was lower than that in CKD4(P<0.05).There was no significant difference in phosphorus levels between CKD5 and CKD4,while the phosphorus level in CKD5 was higher than that in CKD4 stage(P<0.001).There was no significant difference in iPTH levels between CKD5 and CKD4.There was no statistically significant difference inALP level between stages(P>0.05).3.The compliance rates of serum calcium and phosphorus in CKD5 were all lower than those in CKD4,while the compliance rates of serum calcium and phosphorus in CKD5 and CKD4 showed no statistically significant difference.4.The results of correlation analysis showed that there was positive correlation between serum calcium and serum magnesium before hemoglobin albumin.Blood phosphorus was positively correlated with prealbumin magnesium.IPTH was positively correlated with prealbumin,but not with serum magnesium.25-(OH)D was negatively correlated with iPTH and positively correlated with glomerular filtration rate.5.Binary logistic regression analysis showed that age,gender and diabetes history were independent risk factors for IMT thickening.Low albumin in age during dialysis is an independent risk factor for abdominal aortic calcification.Gender,dialysis time,TC,HDL serum calcium in no or mild abdominal aortic calcification group and moderate and severe abdominal aortic calcification group has statistical difference.Conclusions:1.Calcium and phosphorus metabolism is related to the nutritional status of patients with CKD,such as albumin and prealbumin,suggesting that the management of calcium and phosphorus should also cooperate with the guidance of nutritionists to reduce the occurrence of protein-energy wasting in patients with CKD.2.Calcium and phosphorus metabolism is related to magnesium,suggesting that magnesium balance may be related to calcium and phosphorus metabolism.3.Calcium and phosphorus metabolism is involved in the process of vascular calcification,including age,diabetes history,age of dialysis,blood lipid,and low protein.Therefore,the management of these risk factors for vascular calcification should be emphasized in clinical practice to delay the progression of chronic kidney disease. |
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