Cross-sectional Investigation On Calcium And Phosphorus Metabolism In Maintenance Hemodialysis Patients From A Single Center

Background With the continuous improvement of people’s living standards,Uremia incidence increased year by year, not only in developed countries, but also in developing countries. Uremia is one of the main causes of death. According to statistics, the prevalence of CKD was about l0% in China. Hemodialysis in the main alternative therapies for end-stage renal disease(ESRD). It is modern philosophy and goals that efforts to improve the quality of life and improve long-term survival of dialysis patients. In 2005, In the "mineral metabolism and bone disease" conference, the KDIGO clearly stated that "chronic kidney disease- mineral and bone abnormalities(CKD-MBD) concept. CKD-MBD as a common complication of chronic kidney disease, CKD-MBD with the patient’s cardiovascular calcification, cardiovascular morbidity and mortality are closely related, serious impact CKD patients and the quality of life and survival time in long-term dialysis. With the increase prevalence of CKD-MBD, cardiovascular calcification, cardiovascular morbidity and mortality significantly increased in CKD patients, CKD and long-term hemodialysis patients quality of life and survival of severely were affected. Secondary hyperparathyroidism(secondary hyperparathyroidism, SHPT) is common serious complication in chronic kidney disease. It is can cause bone disease, soft tissue and vascular calcification. The incidence rate of up to 40.1%- 95.5%, seriously affecting the quality of life of patients, and with patients incidence and mortality are closely related.Objective To explore the morbidity,management and risk factors of the chronic kidney disease-mineral and bone disorder(CKD-MBD) in maintenance hemodialysis(MHD) patients in our hemodialysis center.Methods A total of 203 patients receiving MHD in our hemodialysis center during the period of Apr. 2013 to Mar.2014 were analyzed in First People’s Hospital of Chuzhou.Demographic information and CKD-MBD related indicators including serum phosphorus,calcium and i PTH were collected.Multivariate logistic regression analysis was used to identify the risk factors for i PTH level and vascular calcification.Results1. In the 203 patients,the prevalence of hypercalcemia,hypocalcemia,hyperphosphatemia,hypophosphatemia,elevated i PTH and reduced i PTH was 24.63%,5.42%,43.35%,9.36%,42.36% and 25.62%,respectively.As a result,97.54% patients met the diagnosis criteria of CKD-MBD. 2. The percentage of patients with the recommended standard level of serum calcium,phosphorus and i PTH was 69.95%,48.77%,and 32.02%,respectively,and only 17 patients(8.37%) achieved all the three recommended standard levels.The rate of senlm calcium and phosphorus levels consistent with the recommended standards were lower than those in DOPPS4. 3. Multivariate logistic regression analyses demonstrated that the risk factors for elevated i PTH were hyperphosphatemia,hypocalcemia and alkaline phosphatase,and those for reduced i PTH were dialysis duration,age,history of taking calcium,and history of taking activated vitamin D.Conclusions MHD patients have a higher incidence of MBD.The rate of CKD-MBDrelated markers consistent with the recommended standards were lower than those in DOPPS4.The CKD-MBD complications are harmful.Detection of calcium,phosphorus and i PTH,and correction of calcium,phosphorus and i PTH disorders timely can reduce the incidence of dialysis-related MBD.