The Clinical Study Of Chronic Kidney Disease-Mineral And Bone Disorder(CKD-MBD)

Objectives:Analyze the incidence of CKD-MBD,including the abnormalities and standard reaching rate of blood calcium,blood phosphorus,parathyroid hormone(PTH),25-hydroxy vitamin(25(OH)D)and cardiovascular calcification.Analyze the variance of MBD among CKD2-5 phases to study whether there is statistical significance.Study the risk factors of cardiac remodeling,cardiovascular calcification,secondary hyperparathyroidism(SHPT)on CKD patients.Methods:Collected 238 cases with CKD2-5 phases hospitalized in the nephrology department of the first Affiliated Hospital of Kunming Medical University.Collect the patient's informations:gender,age,weight,laboratory data,use of calcium carbonate and activated vitamin D.Analyze the incidence of CKD-MBD.Analyze the variance of MBD among four phases,whether there is statistical significance.Study the risk factors of cardiac remodeling,cardiovascular calcification,SHPT on CKD patients.Results:1.238 cases were included,male 153 cases(64.3%),female 85 cases(35.7%),mean age was 50.47±15.60 years old,average BMI was 23.33±3.53kg/m2,average duration of CKD was 24.00±57.00 monthes.Proportion of the primary disease of CKD patients:35%of chronic nephritis,33%of diabetic kidney disease,12%of high blood pressure kidney disease,5%of gouty nephropathy,4%of polycystic kidney,2%of obstructive nephropathy,2%of allergic purpura nephritis,1%of ANCA associated vasculitis,1%of multiple myeloma,1%of membranous nephropathy.2.The incidence of normal,lower,higher blood calcium of patients with CKD was:43.2%,47.9%,8.9%;The incidence of normal,lower,higher blood phosphorus of patients with CKD was:53.9%,11.7%,34.3%;The incidence of normal,lower,higher PTH of patients with CKD was:37.6%,48.1%,14.3%;The incidence of lower,inadequate,balanced(25(OH)D of patients with CKD was:29.8%,63.2%,7.0%;The incidence of cardiovascular calcification of patients with CKD was 29.5%.3.The incidence of normal,lower,higher blood calcium among CKD2-5 phases were different with statistical significance(x2=13.705,P=0.018).The incidence of normal,lower,higher blood phosphorus among CKD2-5 phases were different with statistical significance(x2=28.806,P=0.000).The incidence of normal,lower,higher PTH among CKD2-5 phases were different with statistical significance(x2=17.068,P=0.004).The incidence of lower,inadequate,balanced 25(OH)D among CKD2-5 phases were different without statistical significance(x2=8.476,P=0.150).The incidence of cardiovascular calcification among CKD2-5 phases were different without statistical significance(x2=-4.358,P=0.200).4.Mutivariate logistic regression analysis showed,to CKD patients:gender(male)(P=0.049,OR=0.428,95%CI=0.176-0.944),history of diabetes(P=0.004,OR=10.306,95%CI=2.148-49.461),high diastolic blood pressure(P=0.005,OR=4.58,95%CI=1.577-13.298),high blood phosphorus(P=0.032,OR=3.077,95%CI= 0.111-0.955)were independent risk factors of incidence of cardiac remodeling.5.Mutivariate logistic regression analysis showed,to CKD patients:advanced age(P=0.001,OR=1.085,95%CI=1.033-1.139),history of diabetes(P=0.031,OR=4.537,95%CI=1.152-17.872),high alkaline phosphate(P=0.024,OR=8.660,95%CI=1.332-56.301),high blood calcium(P=0.029,OR=9.934,95%CI=1.265-77.982)were independent risk factors of incidence of cardiovascular calcification6.Univariate logistic regression analysis showed,to CKD patients:eGFR was influence factor of incidence of SHPT(P=0.009,OR =0.587,CI=0.394-0.877).Conclusions:1.The incidence of CKD-MBD is high,the standard reaching rate of MBD is not high:43.2%for blood calcium,53.9%for blood phosphorus,37.6%for PTH,25%for 25(OH)D,the incidence of cardiovascular calcification is 29.5%;MBD happens from earlier stage of CKD(CKD2 phase).2.To CKD patients,gender(male),history of diabetes,high diastolic blood pressure,high blood phosphorus were independent risk factors of incidence of cardiac remodeling.3.To CKD patients,advanced age,history of diabetes,high alkaline phosphate,high blood calcium were independent risk factors of incidence of cardiovascular calcification4.To CKD patients,eGFR was influence factor of incidence of SHPT.