| Objective:This study collected data on anemia patients with chronic kidney disease(CKD)and analyzed the various factors that affect anemia to improve the clinical understanding of the factors affecting renal anemia and to guide its associated treatment,and ultimately improve the prognosis and life quality of patients with CKD.Methods:The clinical data of 202 inpatients with chronic kidney disease who were diagnosed as chronic kidney disease from January 2015 to September 2017 in Jilin University were collected.All 202 patients with CKD were in accordance with the diagnostic criteria of CKD defined by the Nephrology/Dialysis Clinical Practice Guidelines(K/DOQI)written by the American Nephrology Foundation in 2002.The diagnosis of anemia was in line with the 2006 K/DOQI Renal Anemia Guide.In111 cases,91 cases of women,aged 19 to 81 years,with an average age of 55.88±14.39 years.According to the 2002 K/DOQI proposed chronic kidney disease staging criteria,1 stage of 6 cases,2 stage of 16cases,3 stage of 49 cases,4 stage of 57 cases,5 stage of 74 cases.The causes of chronic kidney disease were as follows:90 cases(44.6%)of chronic glomerulonephritis,64 cases of diabetic nephropathy(31.7%),34cases of hypertensive nephropathy(16.8%)and 4 cases of uric acid nephropathy(2%)4 cases of cystic nephropathy(2%),1 case of obstructive nephropathy(0.5%)and 5 cases of other causes(2.4%).Patients’age,sex,height,weight,hemoglobin,urea nitrogen,serum creatinine,cystatin C,retinol binding protein,serum iron,calcium,phosphorus,blood lipids,urinary micro protein,24h urinary protein,parathyroid hormone,albumin and other indicators,while calculating GFR,BMI,to explore the occurrence of renal anemia and its impact on renal function,while analysis of factors that affect renal anemia,to explore the relationship between the factors and hemoglobin.At the same time,calculate the sensitivity and specificity of PTH in the diagnosis of renal anemia in CKD patients.SPSS 21.0 statistical software analysis of the results.Results:1、The general situation analysis:(1)The composition of the primary disease:the cause of chronic kidney disease as follows:90 cases of chronic glomerulonephritis(44.6%),64 cases of diabetic nephropathy(31.7%),34 cases of hypertensive nephropathy 16.8%),4 cases of uric acid nephropathy(2%),4 cases of polycystic kidney disease(2%),1 case of obstructive nephropathy(0.5%)and 5 cases of other causes(2.4%).(2)The overall anemia:Among 202 patients,there were 149 cases(73.76%)with anemia and 53 cases(26.24%)with anemia.(3)The incidence of anemia in all age groups:70 cases(67.31%)were less than 60 years old,72 cases(79.12%)were 60-80 years old and 7(100%)was over 80 years old.(4)There were 77 males(69.37%)and 72 females(79.12%).(5)The incidence of anemia in different BMI(kg/m~2)was lower than 18.5 in 11(91.67%),18.5-23.9 49 cases(72.06%)were overweight in 24-27,16cases(28.5%)were obese in 28-32 cases,and 1 case(25%)was overweight and obese.(6)The incidence of anemia of different primary disease:63 cases of chronic glomerulonephritis,accounting for 70.00%;51 cases of diabetic nephropathy,accounting for 79.69%;23 cases of hypertensive nephropathy,accounting for 67.65%.(7)The incidence of anemia in different stages of CKD:1 case of CKD1 anemia,accounting for 16.67%;CKD2 anemia in 3 cases,accounting for 18.75%;CKD3anemia in 18 cases,accounting for 36.73%;CKD4 anemia in 55 cases,accounting for 96.49%72 cases of CKD5 anemia,accounting for 97.30%.The incidence of stage 4 and stage 5 anemia was higher than that of stage1,2 and 3 of CKD(P<0.05).2、The analysis of influencing factors of glomerular filtration rate(GFR)in patients with CKD:hemoglobin,BMI,iron,cystatin C,urinaryα1-microglobulin and GFR changes were related,the differences were statistically significant(p<0.05).3、Univariate analysis of CKD patients with anemia:(1)The age of anemia group was higher than that of non-anemia group,and the BMI value of anemia group was lower than that of non-anemia group(P<0.05),the people of CKD4、5 stage anemia is higher than non-anemia,but there was no significant difference between non-anemia group and anemia group(P>0.05).(2)Biochemical index:The levels of serum phosphorus,urea,creatinine,retinol binding protein,cystatin C,alkaline phosphatase,urine microalbumin,parathyroid hormone and 24 hours urine protein in anemia group were significantly higher than those in non-anemia group(P<0.05).The difference of total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol in non-anemia group and anemia group was significantly higher than that in non-anemia group.There was no statistical significance(P>0.05).The difference of triglyceride between non-anemia group and anemia group was close to statistical significance(P=0.078).4、Logistic regression analysis showed that cystatin C(OR=2.884,95%CI:1.208-6.889,p=0.017),CKD stage(OR=2.345,95%CI:1(OR=0.888,95%CI:0.797-0.988,p=0.035),urinaryα1-microglobulin(OR=1.027,95%CI:1.006-1.049,0.030),so cystatin C,CKD staging,urineα1-microglobulin is a risk factor for anemia in CKD patients,iron is a protective factor;and triglycerides on anemia was not statistically significant(P>0.05).5、Correlation analysis of some indexes of CKD patients and hemoglobin:Pearson correlation analysis showed that age,CKD staging,BMI,blood calcium,blood iron,phosphorus,urea nitrogen,creatinine,retinol binding protein,cystatin C,alkaline phosphatase,albumin,urine micro protein,parathyroid hormone,24 hours urinary protein and hemoglobin was statistically significant(P<0.05).Among them,BMI,calcium,iron,triglyceride,albumin correlation was positive,the other indicators of negative correlation.6、The critical value of PTH diagnosis anemia was 110.05pg/ml,indicating that the parathyroid hormone exceeded this level,and was prone to diagnosis of anemia,with the sensitivity of 67.1%and 90.6%specificity.Conclusion:1、Most patients with CKD with anemia,including the older,the smaller the BMI,CKD patients with higher CKD stage,more prone to anemia.2、Patients with diabetic nephropathy more prone to anemia,followed by chronic glomerulonephritis,hypertensive nephropathy.3、Hemoglobin level is the influencing factors of GFR changes in CKD patients.4、α1-microglobulin Urine(one of microalbuminuria),cystatin C and blood iron levels are the influencing factors of anemia in CKD patients.The higher the level of urinaryα1-microglobulin、cystatin C and the lower the iron level,the more prone to anemia.5、CKD patients with higher PTH levels,lower hemoglobin,when the PTH level exceeds 110.05pgml,diagnosis of renal anemia higher specificity.And PTH should be actively controlled at this level in clinical treatment of renal anemia. |
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