| Objective To analyze the differences and influences of intact parathyroid hormone(iPTH)levels and 25 hydroxy vitamin D3[25(OH)D3]levels in ESRD maintenance dialysis patients with diabetes mellitus or not.Method 180 patients who underwent maintenance hemodialysis and 99 patients who underwent maintenance peritoneal dialysis,without parathyroidectomy were selected.in Blood Purification Center and in peritoneal dialysis Center of the First Affiliated Hospital of Nanjing Medical University,from January to December 2015,In maintenance hemodialysis patients,they were divided into two groups:those with DM as a diabetic hemodialysis group(DH),those without DM as a non-diabetic hemodialysis group(NDH).In maintenance peritoneal dialysis patients,those with DM as a diabetic peritoneal dialysis group(DP),those without DM as a non-diabetic peritoneal dialysis group(NDP).The clinical data between DH and NDH,DP and NDP were compared respectively.and analysis of possible influencing factors of iPTH and 25(OH)D3 levels were carried out.Results The level of iPTH in DH group was significantly lower than that in NDH group[219.7(164.1?275.2)pg/ml VS 500.39(398.1?602.7)pg/ml,Z=-4.473,P<0.001].Similarly,the level of 25(OH)D3 in DH group was also significantly lower than that in NDH group[(30.9±16.0)pg/ml VS(45.2±25.1)pg/ml,t=-3.327,P=0.001].The level of serum iPTH was negatively correlated with history of diabetes(r=-0.339,P<0.001),and positively correlated with dialysis years(r=0.386,P<0.001),serum phosphatase,(r=0.437,P<0.001),alkaline phosphatase(r=0.426,P<0.001)and 25(OH)D3(r=0.254,P=0.016).The multiple linear regression analysis showed that history of diabetes(?a=-0.173,Pa=0.012)and years of dialysis(pa=0.147,Pa=0.028)were independent factors of iPTH.The concentration of serum 25(OH)D3 was negatively correlated with history of diabetes(r=-0.296,P=0.004),and positively correlated with dialysis years(r=0.228,P=0.030),serum phosphatase(r=0.237,P=0.023),serum magnesium(r=0.286,P=0.007),serum albumin(r=0.263,P=0.012)and iPTH(r=0.254,P=0.016).The multiple linear regression analysis showed that the history of diabetes(pa=-0.317,Pa=0.004)was independent factor of 25(OH)D3.The level of iPTH in DP group was also lower than that in NDP group[(257.7±211.1)pg/ml ?(394.7±338.9)pg/ml,t=-2.260,P=0.028].In patients with peritoneal dialysis,the level of serum iPTH was negatively correlated with glycosylated hemoglobin(r=-0.342,P<0.003),hemoglobin(r=-0.207,P<0.045)and correction of calcium.and positively correlated with serum phosphatase,(r=0.381,P=0.000),alkaline phosphatase(r=0.256,P=0.013).The multiple linear regression analysis showed that in patients with peritoneal dialysis glycosylated hemoglobin(?a=-0.213,Pa=0.040)anderum phosphatase(?a=0.278,Pa=0.024)were independent factors of iPTH.The concentration of serum 25(OH)D3 in MPD was negatively correlated with age(r=-0.217,P=0.044),and positively correlated with hemoglobin(r=0.287,P=0.007),serum albumin(r=0.329,P=0.002)and urea nitrogen(r=0.242,P=0.024).The multiple linear regression analysis showed that in MPD hemoglobin(?a=0.284,Pa=0.009)was independent factor of 25(OH)D3.Conclusion The levels of iPTH in MHD and MPD patients with diabetes mellitus were significantly lower than those in non-diabetic group(P<0.05).In maintenance hemodialysis patients,the history of diabetes is an independent influencing factor for iPTH and 25(OH)D3.In maintenance peritoneal dialysis patients,glycosylated hemoglobin and serum phosphorus are independent factors of iPTH,hemoglobin is 25(OH)D3 independent influencing factors. |
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