| Objective:To explore the morbidity and the management of the chronic kidney disease-mineral and bone disorder (CKD-MBD) in maintenance hemodialysis (MHD) patients at our hospital center, to analyze the reasons and the related risk factors.Methods:The target population was the 217 patients who took treatment of hemodialysis in hemodialysis center of our hospital during Jul.2010 to Mar.2011. We gathered the demographic information and the CKD-MBD related indicators (Ca, P, ALP and radiography of vascular calcification), and other data of laboratory examination at the meantime. We assessed the nutritional state of patients with skill of the subjective global assessment of nutrition (SGA). Vascular calcifications were determined by lateral abdominal, frontal pelvic and hand X-rays. Then we analyzed the situation of reaching the standard which according to the recommendations of "2003 K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease". We divided the patients in to different subgroups on the basis of different levels of serum Ca, P, PTH and the situation of vascular calcification. Then we separately compared multiple clinical indicators among different subgroups which include sex, age, cause of the kidney disease, duration of the chronic kidney disease, duration of the hemodialysis, history of hypertension, history of diabetes, history of taking activated vitamin D, history of taking calcium carbonate, BMI (body mass index), HB, PTH, calcium, phosphorus, ALP, predialyzed serum creatinine, Kt/V, ALB, CHOL, TG, HDL, LDL, FER, CRP and so on. Finally analyze the potential relative risk factors of the abnormalities of the indicators by the multi-variance Logistic regression analysis.Results:217 patients were evaluable for this study; F/M=108/109, mean age=59.88±15.6years, mean range of duration of CKD=94.88±96.14 months, mean range of duration of hemodialysis=46.49±41.25months. The morbidity of hyperphosphatemia, hypophosphatemia, hypercalcinemia, hypocalcemia, reduced PTH and elevated PTH were 45.16%,10.14%,31.80%,21.66%,20.74% and 48.39% respectively. Only 20 patients achieved all the recommended standard levels of serum calcium, phosphorus, PTH, accounting for 9.22% of the whole population. On X-rays,154 patients (70.94% of the whole population) had evidence of vascular calcification, among which 47.00% were mild in severity (calcification score of 1～3),17.05% were moderate in severity (calcification score of 4～6),6.91% were severe in severity (calcification score above 6). The proportion of patients meeting the criteria of CKD-MBD was as high as 96.31%, who had a disorder of calcium, phosphorus, PTH, vascular calcification, or combination of these disorders. The percentage of patients who achieved the recommended standard levels of serum calcium, phosphorus, PTH were 45.16%,44.7% and 30.88% respectively. From the multi-variance Logistic regression analysis, the potential relative risk factors were as follows:hyperphosphatemia:predialyzed serum creatinine and TG; hypophosphatemia: hypercalcinemia; hypocalcemia:hyperphosphatemia and elevated PTH; hypercalcinemia: duration of CKD and the history of diabetes; elevated PTH:duration of HD,hyperphosphatemia and hypocalcemia; reduced PTH:advanced age and history of taking activated vitamin D; vascular calcification:advanced age, ALP, hyperphosphatemia and CRP.Conclusion:In accordance to of "2003 K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease", the morbidity of CKD-MBD in the MHD patients at our hemodialysis center is as high as 96.31%. The risk factors are advanced age, duration of CKD, duration of HD, history of diabetes, predialyzed serum creatinine, history of taking excess activated vitamin d, and the level of TG, ALP and CRP. |
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