| Objective:To compare the effects of different dialysis methods on calcium and phosphorus metabolism in patients with end-stage renal disease,and to provide clinical evidence for improving the calcium and phosphorus metabolism disorder in patients with ESRD.Methods:1.512 patients treated with HD or PD for more than 3moths in our hospital from Jan.1,2012 to Dec.31,2015 were enrolled.The selected patients were with stable disease,excluded tumor,infection,autoimmune disease,severe liver disease,heart failure.276 patients with hemodialysis and peritoneal dialysis in the treatment of 236 cases,All patients were divided into 5 groups,3 mon <M?12mon,12 mon <M?24mon,24 mon <M?36mon,36 mon <M?48mon,>48mon according to their therapy durations(M).The patient's basic information and laboratory indicators were collected,such as Intact parathyroid hormone(iPTH),serum calcium,phosphorus,calcium phosphorus product,blood pressure,Creatinine and urea nitrogen before dialysis,?2 microglobulin,glycerin three greases,Cholesterol,albumin,hemoglobin,Kt/V data.The differences of the above indexes in two dialysis groups were analyzed;To count the compliance rate of calcium,phosphorus,iPTH,calcium and phosphorus with the two dialysis ways(According to the KDIGO guidelines: serum total calcium : 2.1-2.37mmol/L,phosphorus:1.13-1.78mmol/L,calcium and phosphorus product 55mg2/dl2,iPTH :100-300pg/ml),and factors of calcium and phosphorus metabolism disorders were studied for HD patients and PD patients using multiple regression analysis.2.For comparison the effects of different blood purification ways in hemodialysis(HD),high flux hemodialysis(HFHD),hemodialysis combined with hemodiafiltration(HD+HDF),regular hemodialysis combined with hemoperfusion(HD+HP)on calcium-phosphorous metabolism of maintenance hemodialysis patients,48 cases of patients with maintenance hemodialysis more than 3 months in our hospital were enrolled,who were with stable disease and excluded from the patients with tumor,infection,immune system disease,severe liver disease,heart failure diseases.There were 26 males and 22 females,aged 33-86 years old,with an average age of 55.98±13.67 years old,the age of dialysis was 6-50 months,with an average age of dialysis of 32.41±14.17.19 cases of chronic glomerulonephritis,hypertensive nephropathy in 11 cases,diabetic nephropathy in 14 cases,the others were 4 cases.All subjects underwent a 8 week washout period,that is application of German Fresenius FX8 hemodialysis therapy for 8 weeks,3 times a week dialysis,4 hours each time.Patients at the end of treatment for 8 weeks were divided into four groups according to random number: hemodialysis group(HD),high flux hemodialysis group(HFHD),hemodialysis combined with hemodiafiltration group(HD+HDF),regular hemodialysis combined with hemoperfusion group(HD+HP),Dialysis machine using 4008 B dialysis machine and 4008 S hemodialysis machines from German Fresenius company,dialyzers with low flux dialyzer disposable FX8 and high-throughput disposable FX60 dialyzer from Germany Fresenius company,perfusion using HA130 from Zhuhai Jianfan company,a disposable device.The dialysis blood flow was set to 4 times of the body weight,the dialysate flow rate was 500ml/min,and the dialysis time was about 4 hours.The treatment of the four groups is as follows : HD group of 12 cases,dialysis 3 times a week,4 hours each time;12 cases in group HFHD,dialysis 3 times a week,4 hours each time;12 cases in group HD+HDF,2 times a week,1 times of hemodialysis,hemodiafiltration;12 cases in group HD+HP,2 times a week of hemodialysis,1 times of hemodialysis combined hemoperfusion.The serum calcium,phosphorus and intact parathyroid hormone were measured in 0,1,3,6 month each group.The measured data are expressed as mean±standard deviation,The data were processed by statistical normality and homogeneity of variance test,To observe and compare the change for 0,1,3 and June about serium calcium and phosphorus,parathyroid hormone index.Results:1.the compliance rates of calcium,phosphorus,iPTH,calcium-phosphorus product about HD patients were 55.1%,39.1%,17.3%,54.7% respectively,and 57.6%,47.8%,35.1%,69.1% about PD patients.the compliance rates showed higher comparing with the HD group,while iPTH and calcium-phosphorus product showed no significant difference.2.No significant difference was found in calcium concentration between HD and PD for all therapy duration groups.However,concentrations of phosphorus and i PTH were significantly different between HD and PD for the groups 24-36 mon,36-48 mon and >48mon,and differences of calcium-phosphorus product between HD and PD for groups 36-48 mon and >48mon were also statistically significant.3.Multiple logistic regression analysis revealed that age(OR=1.045),dialysis duration(OR=1.325),Hemoglobin(OR=1.226),triglyceride(OR=6.742),?2 microglobulin(OR=2.543)and Kt/V(OR=9.372)were factors of calcium and phosphorus metabolism disorders for HD patients.Age(OR=1.610),dialysis duration(OR=1.225),?2-microglobulin(OR=4.043)and Kt/V(OR=11.372)were factors of calcium and phosphorus metabolism disorders for PD patients.4.Comparison of different blood purification methods on calcium,phosphorus and i PTH:(1)Intact parathyroid hormone(iPTH): Two factor repeated measures ANOVA,test of sphericit: W=0.545,p<0.001,dissatisfaction with the sphericit hypothesis,the application of Greenhouse-Geisser adjustment,correction factor: 0.356.Comparison of main effects: Among the 4 groups,4 time points,interaction time and group were statistically significant(P<0.05),suggesting that i PTH changes greatly in different blood purification methods and different time points,and the variation by grouping effect.Comparison among groups: The difference between the four groups was statistically significant.Application of single factor analysis of variance between groups indicate that in 3,6 months,HFHD group,HD + HDF group and HD+HP group parathyroid hormone levels were decreased than HD group significantly(P<0.05),in 6 month,HFHD group than HD+HDF group and HD+HP group have low levels of parathyroid hormone(P<0.05),parathyroid hormone levels decreased gradually with the prolongation of treatment time of HFHD group,HD+HDF group and HD+HP group.(2)Serium phosphorus(P): Two factor repeated measures ANOVA,test of sphericit: W=0.281,p<0.001,dissatisfaction with the sphericit hypothesis,the application of Greenhouse-Geisser adjustment,correction factor: 0.241.Comparison of main effects: Among the 4 groups,4 time points,interaction time and group were statistically significant(P<0.05),The results showed that the changes of serum phosphorus in different blood purification methods and different time points were very large,and the trend of change with time was affected by the group.Comparison among groups: The difference between the four groups was statistically significant.Application of single factor analysis of variance between groups indicate that in 6 months,HFHD group and HD + HDF group,HD+HP group and HD group were statistically significant(P<0.05);in the 3 and 6 month group,blood phosphorus in HFHD group and HD + HDF group higher than those in HD group(P<0.05);serum phosphorus levels decreased gradually with the prolongation of treatment time of HFHD group,HD+HDF group.(3)Calcium(Ca): Two factor repeated measures ANOVA,test of sphericit: W=0.623,p=0.001,dissatisfaction with the sphericit hypothesis,the application of Greenhouse-Geisser adjustment,correction factor: 0.241.Comparison of main effects: The phosphorus in 4 groups,4 time points,interaction time and group were no statistically significant difference(P>0.05),suggesting that the changing of the calcium in different blood purification methods and different time points had no significant difference.The changes trend with time were unaffected by grouping.Conclusion:1.calcium and Phosphorus metabolism disorders for ESRD patients is prevalent,and patients treated with PD has lower risk of ESRD than patients treated with HD.2.To improve the adequacy of dialysis can improve hemodialysis and peritoneal dialysis patients with calcium and phosphorus metabolism,improving anemia,lipidlowering and strengthen the integration therapy is helpful to correct calcium and phosphorus metabolism in hemodialysis patients.3.Different blood purification methods have different scavenging effect of Ca,P,iPTH.simple hemodialysis is difficult to correct the disorders of calcium and phosphorus metabolism;high flux hemodialysis,hemofiltration and hemodialysis combined with hemoperfusion on serum phosphorus and parathyroid hormone scavenging effect than hemodialysis,Among them,high flux hemodialysis is more advantageous to the clearance of serum phosphorus and parathyroid hormone,which can improve the metabolism of calcium and phosphorus in maintenance hemodialysis patients. |
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