| Objective: To study serum calcium(Ca),serum phosphorus(P),calcium-phosphorus product(Ca×P),parathyroid hormone(PTH)in maintenance hemodialysis patients at various dialysis sessions and recent compliance,and study the effects of calcium and phosphorus metabolism on the cardiovascular system in Jilin University Second Hospital.Methods: Retrospective analysis was performed on the clinical data of 317 patients who underwent hemodialysis and had a dialysis time of more than 3 months from December 1,2012 to November 30,2017 in Jilin University Second Hospital.age,sex,Primary disease,hypertension,diabetes,Ca,P,Ca×P,PTH,hemoglobin(Hb),blood pressure,and patient dialysis 1 year,2 years,3 years,4 Years,5 years,November 2017 Ca,P,Ca×P,PTH,Hb,blood pressure,dialysis age,weight,height,Left ventricular end diastolic diameter(LVED),interventricular septal thickness(IVST),Left ventricular posterior wall thickness(LVPWT),lung CT,etc.The statistical software SPSS21.0 was used to analyze the control of Ca,P,Ca×P,PTH and other indicators,as well as the relationship between long-term high concentrations of Ca,P,Ca×Pand PTH and the occurrence and development of cardiovascular diseases.Result: 1.the general situation:This study included a total of 317 patients,with an average age of 56.83±13.95 years;164 men(51.7%)and 153 women(48.3%);278(87.7%)with hypertension;and 104(32.8%)with diabetes;The primary disease was diabetic nephropathy and chronic glomerulonephritis with the same proportion of 30.9%.The other primary diseases were hypertension nephropathy,polycystic kidney,interstitial nephritis,vasculitis,and other primary diseases.2.the efficacy of the situation: The rate of reaching the Ca standard in patients who had dialysis for the first time for one year,two years,three years,four years,five years and recent dialysis was 38.7%,42.9%,39.6%,41.1%,34.5%,40.0%,and 50.5% respectively.The rate of reaching the P standard was 35.6%,43.8%,39.0%,35.7%,46.0%,38.9%,and 47% respectively.The rate of reaching the Ca×P standard was 68%,70.8%,67.6%,65.9%,69.0%,63.2%,and 63.1% respectively.The rate of reaching the PTH standard was 27%,29.2%,30.2%,19.4%,24.1%,27.4%,and 28.7% respectively.3.The relationship with the cardiovascular system:(1)There was a positive correlation between P,Ca,Ca×P,PTH and calcification of thoracic/abdominal aorta in hemodialysis patients,the difference was statistically significant(P<0.05).There was a positive correlation between P,Ca×P,and PTH and the calcification of heart valves,the difference was statistically significant(P<0.05).There was no correlation between dialysis age and calcification of the thoracic/abdominal aorta and calcification of heart valves,the difference was not statistically significant(P>0.05).There was a positive correlation between P,Ca×P,PTH and left ventricular mass index(LVMI)(P<0.05).There was a negative correlation between dialysis age andLVMI,and the difference was statistically significant(P<0.05).There was no correlation between serum calcium and LVMI,and the difference was not statistically significant(P>0.05).(2)PTH was divided into low high,middle and low groups.There was a significant difference in LVMI between the three groups(F=46.228,P=0.000).The LVMI in high PTH group was significantly higher than that in low PTH group and middle PTH group(P=0.000,P<0.05).There was no significant difference in LVMI between low PTH group and middle PTH group(P=0.296,P>0.05).The calcification of the thoracic/abdominal aorta in the high PTH group was significantly greater than that in the low PTH group and the middle PTH group,with statistically significant differences(x2=3.984,P=0.046;x2=20.171,P= 0.000).There was no statistically significant difference in thoracic/abdominal aortic calcification between the low PTH group and the middle PTH group(x2=1.105,P=0.293).Calcification of heart valves in high PTH group was significantly higher than that in low PTH group and middle PTH group,and the difference was statistically significant(x2=16.845,P=0.000;x2=26.718,P=0.000).There was no significant difference in cardiac valve calcification between low PTH group and medium PTH group(x2= 0.318,P= 0.573).(3)High P(OR=4.165,95%CI:2.474~7.013),high Ca×P(OR=6.317,95%CI:3.480~11.469),and high PTH(OR=10.079,95%CI: 5.541~18.335)were the risk factors of left ventricular hypertrophy,the difference was statistically significant(P<0.05).High P(OR=5.852,95%CI:3.518~9.733),high Ca×P(OR=23.116,95%CI:11.830~45.168)and high PTH(OR=4.166,95%CI:2.491~6.802)were the risk factors for cardiac valve calcification,the difference was statistically significant(P<0.05). High P(OR=4.173,95% CI: 2.548~6.834),high Ca×P(OR=36.574,95% CI: 15.409~86.810)and high PTH(OR=3.079,95%CI:1.890~5.016)were the risk factors for calcification of thoracic/abdominal aorta,the difference was statistically significant(P<0.05).Conclusion: 1.The proportion of chronic glomerulonephritis and diabetic nephropathy were similar in maintenance hemodialysis patients of this dialysis center.2.The compliance rate of Ca,P and PTH were higher than that in the first dialysis in the maintenance hemodialysis patients of this dialysis center,but it was not significant.3.The relationship between Ca,P,Ca×P,PTH and thoracic/abdominal aortic calcification were positively correlated.The relationship between P,Ca×P,PTH and LVMI,cardiac valve calcification were positively correlated in maintenance hemodialysis patients of this dialysis center.4.High P,high Ca×P,and high PTH were risk factors for left ventricular hypertrophy,calcification of heart valves,and calcification of thoracic/abdominal aorta in maintenance hemodialysis patients of this dialysis center. |
PDF Full Text Request