Investigation Of Calcium And Phosphorus Metabolism Disorders In Patients With Maintenance Hemodialysis And Its Relationship With TCM Syndrome Type

Purpose:To investigate the disorder of calcium and phosphorus metabolism in MHD patients from the Blood Purification Center and inpatients in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine and explore the correlation between calcium and phosphorus metabolism disorders and clinical indicators in MHD patients,screen risk factors,and search for early warning indicators of cardiac dysfunction in patients with calcium and phosphorus metabolism disorders.This study explored the TCM syndromes and five state personality distribution in MHD patients with calcium and phosphorus metabolism disorders,thereby providing references for the understanding,prevention,and clinical treatment of these patients,in the hope of improving the quality of life and prognosis of MHD patients.Material and method:83 cases of MHD patients who were treated in the outpatient and ward of the Blood Purification Center of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 2021 to December 2022 and met the inclusion criteria were enrolled.General information,past medical records,and laboratory indicators for retrospective analysis and statistics were collected.The existence of calcium and phosphorus metabolism disorder in MHD patients was determined according to the target ranges of Ca,P and IPTH of MHD patients suggested by KDIGO guidelines.The TCM four diagnostic information of patients was recorded and syndrome differentiation and classification were conducted.Personality assessment was conducted using the Five State Personality Test.A database was established by inputting questionnaire data into Excel and data were analyzed using SPSS25.0.The status and distribution patterns of calcium and phosphorus metabolism disorders in MHD patients,and the relationship between MHD patients and traditional Chinese medicine syndrome types was explored.Results:1.83 MHD patients were included,in which 67(80.72%)patients were diagnosed with calcium and phosphorus metabolism disorders.Among these,49.40% of the patients met the standard of IPTH and 54.22% of patients met the standard of blood calcium.For blood phosphorus,the highest rate was 60.24%.2.Between the two groups of MHD patients(with or without calcium and phosphorus metabolism disorders),the differences in age,dialysis age,education level,preliminary mastery of scientific education,low phosphorus diet,heart rate systolic blood pressure product,normal RPP(RPP<12000),urea nitrogen,hemoglobin were of statistically different(P<0.05).There was no significant difference in gender,primary kidney disease,diabetes history,hypertension history,coronary heart disease history,pre dialysis calcium and phosphorus compliance rate,phosphorus binding agent application,pulse pressure index,blood creatinine,blood creatinine/hemoglobin,serum albumin cholesterol,uric acid as well as C-reactive protein(P>0.05).Secondary regression analysis suggested that risk factors for calcium and phosphorus metabolism disorders in MHD patients included failure in preliminary mastery of scientific education,abnormal RPP and no low-phosphate diet.3.In this study,the distribution of primary deficiency syndrome was as follows: 30 cases(36.14%)of spleen and kidney qi deficiency syndrome>17 cases(20.48%)of spleen and kidney yang deficiency syndrome>15 cases(18.07%)of liver and kidney yin deficiency syndrome>13 cases(15.66%)of both qi and yin deficiency syndrome>8 cases(9.64%)of both yin and yang deficiency syndrome.sthenia syndrome.The distribution of concurrent syndrome was as follows: 21 cases(25.30%)of dampness and turbidity combined with blood stasis syndrome,19 cases(22.89%)of no concurrent syndrome,13 cases(15.66%)of dampness and heat combined with blood stasis syndrome,9 cases(10.84%)of dampness and turbidity syndrome,8 cases(9.64%)of blood stasis syndrome and 4 cases(4.82%)of dampness and heat syndrome.4.The difference between the calcium and phosphorus metabolism disorder in MHD patients and the deficiency syndrome was statistically significant,while the difference between MHD patients and concurrent syndrome was not.In patients with deficiency syndrome,the number of patients reaching the standard of blood calcium,blood phosphorus,and serum IPTH was the highest in patients with spleen and kidney qi deficiency syndrome,while lowest in those with both yin and yang deficiency syndrome.There was a close relationship between damp-heat syndrome and skin itching in MHD patients.5.The distribution of five-pattern personality status in MHD patients showed a trend of more Yin and less Yang。The scores of Taiyin dimensions in the calcium and phosphorus metabolism disorder group were higher than those in the normal group,while the yin and yang balance dimensions were lower than those in normal group,both with statistical significance(P<0.05).There was a positive correlation between calm personality and maintaining a low phosphorus diet in MHD,and a negative relationship between Taiyin personality and maintaining regular dialysis.Binary regression test suggested that,there was a positive correlation between normal calcium and phosphorus metabolism and the personality of calm.Conclusion:1.MHD patients had a high incidence rate of calcium and phosphorus metabolism disorder,with low standard-reaching rate of blood calcium,blood phosphorus,and IPTH.2.No preliminarily mastery of scientific education,and abnormal RPP were risk factors for calcium and phosphorus metabolism disorders in MHD patients.3.In terms of primary deficiency syndrome,MHD patients were mainly of spleen and kidney qi deficiency throughout the disease process.In terms of concurrent syndrome,MHD patients were mainly characterized by dampness and turbidity combined with blood stasis.4.In terms of primary deficiency syndrome,the disorder of calcium and phosphorus metabolism was the most serious in MHD patients with both yin and yang deficiency.MHD patients with spleen and kidney qi deficiency have the best standard reaching rate of blood calcium,blood phosphorus,and serum IPTH.5.There was a positive correlation between calm personality and normal calcium and phosphorus metabolism in MHD patients.