| Objective: To understand relationship between vitamin D concentration in the serum and the nutritional index in maintenance hemodialysis(MHD) patients, and to provide new treatment idea to improve the life quality of MHD patients and to reduce the incidence of complication and mortality.Methods: We selected 120 MHD patients from 2014 June to 2014 December in Affiliated Hospital of Chengde Medical College blood purification room as reseach object. They were 71 males and 49 females aged from 22 to 86 years old, with average of 57.83±14.76 years old, who underwent hemodialysis for 0.25-9.08 years with an average duration of 1.85±1.77 years, collecting general information: include sexuality, age, height, dry weight, Body Mass Index(BMI), hemodialysis years, residual urine volume, systolic blood pressure, diastolic blood pressure, arm circumference, biceps skinfold, triceps skinfold thickness, Modified Quantitative Subjective Global Assessment(MQSGA), checking the serum 25-OH-D3 and other clinical indicators. 25-OH-D3 30-15 ng/ml levels as insufficient standard, less than 15ng/ml for the lack of standards, they were 64 cases of MHD patients 25-OH-D3 insufficient, 56 cases of MHD patients 25-OH-D3 lack, and 25-OH-D3 levels were not normal. The deficiency group and the lack of group were divided on 25-OH-D3, of which the biochemical indexes and the general data were performed statistical analysis on; the MHD patients consist 58 cases of diabetes patients and 62 non-diabetes, who were divided into diabetes group and non-diabetes group, the biochemical index and general data in the two group for statistical analysis. MHD patients in the study were informed and voluntary, and signed the consent form. Dialysis Method: The dialyzer was Fresenius(4008S), with the effective membrane surface area of 1.5-1.7m2, and the dialyzer was the polysulfone membrane dialyzer made by German of Fresenius. The hydrocarbonate dialysis solution(K+ 2mmol/L, Na+ 140mmol/L, Cl- 109.5 mmol/L, Mg2+ 0.5mmol/L, Ca2+ 1.5mmol/L, HCO3- 32mmol/L) was adopted for all the patients. The blood flow was 180-250ml/min, The dialysis solution flow was 500ml/min and the temperature is 36.5 degrees celsius. The hemodialysis was conducted 2-3 times per week, once 4 hours. Low molecular weight heparin and unfractionated heparin was adopted for anticoagulation. internal arteriovenous fistula and Semi-permanent venous catheter into the right carotid was adopted as the vascular access in all cases. All the blood samples were drawn from the cubital vein in the morning after 10-12 hours of fasting and the serum, after centrifugation(3000r/min,10min), was sent for cryostorage at-20 degrees celsius for detective. Enzyme-linked immunosorb--ent was adopted determination of human serum 25-hydroxy vitamin D3 [25-OH-D3] levels, kit purchased from Beijing Bohui Innovation Optoelectro--nic Technology Co, Ltd. And all the blood samples were drawn from the cubital vein in underwent hemodialysis, that brought to in Affiliated Hospital of Chengde Medical College laboratory, Parathyroid hormone PTH, Ferritin FERR, Calciumshot Nmmdia Ca, Phosphorus P, Serumalbumin ALB, Hemogl--obin HGB, Neutrophilicgranulocyte NEUT#, β2-microglobulin β2-MG, Uric acid UA, Serumcreatinine Scr, Bloodureanitrogen BUN etc, that were detected by electrochem ilum and immunochem ilum inescent respectively. Using SPSS17.0 statistical software processing. ALL data using measu--rement data to plus or minus s, said two groups data in test USES independ--ent samples t test, Rates were compared using chi-square test. P<0.05 for the difference was statistically significant. And multiple logistic regressions was applied to study risk factors of 25-OH-D3 deficiency. P<0.1 for the difference was statistically significant.Results: 1 MHD patients with diabetes group compared with the non-diabetes group,25-OH-D3(15.43±6.11 ng/ml vs17.96±5.33 ng/ml, p<0.01),ALB(36.68±4.00 g/L vs38.90±3.85 g/L, p<0.01), β2-MG(18.72±5.45 mg/L vs20.67±5.64 mg/L, p<0.05), BUN(19.97± 6.55 mmol/L vs 23.16±8.21 mmol/L, p<0.05), Scr(713.70±232.82umol/L vs 909.89±279.57umol/L, p<0.01) levels with MHD patients were significantly increased, with statistical significance; the level of MHD patients in age(61.48±12.61year-old vs54.42±15.87 year-old, p<0.01), biceps skinfold(6.36±3.00 cm vs 5.14±2.70 cm, p<0.05), triceps skinfold thickness(13.16 ± 5.64 cm vs 10.95±5.37 cm, p<0.05) markedly decreased, with statistical significance. The table 4 as follows 2 MHD patients with 25-OH-D3 insufficient group compared with the 25-OH-D3 lack group, age(23.27±4.67 year-old vs59.68±14.19 year-old, p<0.01), diabetes(37.5% vs 60.7%, p<0.05) increased, with statistical significance; the level of MHD patients in arm circumference(25.50±2.95 cm vs24.65±2.37 cm, p< 0.05), BMI(23.37±4.58 kg /m2 vs21.46±4.23 kg /m2, p<0.01), ALB(38.43 ±4.28 g/L vs37.09± 3.68 g/L, p<0.05), Scr(854.78±289.71 umol/L vs768.69± 252.26 umol/L, p<0.05) markedly decreased, with statistical significance. The table 5 as follows 3 Logistics regression analysis on the affecting factors of 25-OH-D3 with MHD patients showed BMI(p<0.05), ALB(p<0.05), diabetes(p<0.05) was independent impact factor of 25-OH-D3. The table 6, 7 as followsConclusion: 1 25-OH-D3 deficiency is common among MHD patients. 2 ALB, 25-OH-D3 levels of the diabetes group with MHD patients were significantly lower than the non-diabetes group, which suggested diabetes aggravate malnutrition and 25-OH-D3 deficiency. 3 BMI(p<0.05), ALB(p<0.05), diabetes(p<0.05) of MHD patients were independent impact factor of 25-OH-D3, which Suggested 25-OH-D3 defic--iency correlated with malnutrition. |
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