Influence Of Different Peritoneal Dialysis Methods On Calcium Phosphorous Metabolism In Patients With End Stage Renal Disease

Objective:To compare the effects of different peritoneal dialysis methods on calcium and phosphorus metabolism in patients with end-stage renal disease.We also analyzed the situation of reaching the standard and separately compared multiple clinical indicators among different subgroups.Methods:523 patients treated with APD or CAPD for more than 3 months in our hospital from Sep.l,2012 to Dec.31,2018 were enrolled.54 patients with APD and CAPD in the treatment of 469 cases.The selected patients were with stable disease,excluded infection,acute heart failure,chronic viral hepatitis,tumor,autoimmune disease.ESRD patients with peritoneal dialysis and hemodialysis at the same time,or accepted renal transplantation were excluded as well.The patient's basic information and laboratory indicators were collected,such as renal function(Bun,Scr),glucose and lipid metabolism(GLU,TG,TC,HDL,LDL),inflammation(CRP,Fg),nutrition state(Hb,Alb,ferroprotein)and calcium phosphorus metabolism(Ca,P,iPTH)were measured.The differences of the above indexes in two dialysis groups were analyzed;To count the compliance rate of calcium,phosphorus,iPTH with the two dialysis ways(According to the KDIGO guidelines:serum total calcium:2.15-2.55mmol/L,phosphorus:1.00-1.40mmol/L,iPTH:130-600pg/ml).Then we analyzed the situation of reaching the standard and separately compared multiple clinical indicators among different subgroups.Results:1.the compliance rates of calcium,phosphorus,iPTH about APD patients were 55.56%,7.41%,22.22%respectively,and 61.41%,21.11%,24.09%about CAPD patients.The phosphorus compliance rates showed higher in CAPD group comparing with the APD group,while iPTH and calcium showed no significant difference.2.There is no statistical difference of Ca,iPTH,LDL,TG,HDL,TC,GLU,Fg,CRP,Hb between APD and CAPD for all therapy duration groups.However,concentrations of phosphorus,BUN,SCr,Alb,ferroprotein were significantly different between APD and CAPD groups.3.For CAPD patients,Alb,P,iPTH,SCr,therapy duration were significantly different between the Ca normal group and the abnormal group.There is no statistical difference between the Ca normal group and the abnormal group for APD patients.For CAPD patients,Hb,Alb,iPTH,BUN,SCr,therapy duration were significantly different between the P normal group and the abnormal group.For CAPD patients,Age,P,therapy duration were significantly different between the iPTH normal group and the abnormal group.There is no statistical difference between the iPTH normal group and the abnormal group for APD patients.Conclusion:1.Calcium and phosphorus metabolism disorders for ESRD patients is prevalent,and patients treated with CAPD has lower risk of disorders than patients treated with APD.CAPD is more advantageous to the clearance of BUN and SCr.CAPD patients have a higher incidence of hypoalbuminemia.2.The controlling of serum phosphorus in the PD patients is not ideal in our center.These results suggested that physicians and patients should pay more attentions to improve the situation.