透析患者钙磷IPTH达标率相关因素分析及干预措施研究

Analysis of the related factors and intervention measures of calcium,phosphorus and IPTH compliance rate in hemodialysis patients

目的:探讨血液透析患者的慢性肾脏病-矿物质和骨异常(CKD-MBD)的患病情况,并分析其相关危险因素,制定干预措施。方法:收集患者的一般资料,测定血钙、血磷、血IPTH,分析CKD-MBD各指标在血透患者中达标率以及相关危险因素,根据KDIGO指南制定强化管理策略,比较强化管理1年后达标率的变化。结果:血液透析患者血钙、血磷、IPTH达标率分别为42.97%、42.19%、20.31%。血钙、磷、IPTH均达标仅16例(6.25%)。经多因素Logistic回归分析,高磷血症的危险因素是血透前肌酐水平、TG。高IPTH的危险因素是透析年龄、高磷血症和低钙血症。强化管理后,各项指标的达标率分别为血钙57.8%,血磷59.38%,IPTH 33.2%,3项均达标14.8%。结论:CKD-MBD在维持性血液透析患者中普遍存在,钙、磷、IPTH水平受多种因素影响,强化管理可提高CKD-MBD各项指标达标率。

Objective:To explore the prevalence situation of chronic kidney disease-mineral and bone disorder(CKD-MBD) inhemodialysis patients,and to analyze the related risk factors,and to make intervention measures.Methods:General information ofpatients were collected.We measured serum calcium,serum phosphorus,serum IPTH,and analyzed the compliance rate and relatedfactors of CKD-MBD each index in hemodialysis patients.According to KDIGO guidelines,we made a strengthening managementstrategy,and compared the compliance rate change after 1 year of intensive management.Results:The compliance rate of serumcalcium,serum phosphorus,serum IPTH in hemodialysis patients was 42.97%,42.19%,20.31% respectively.Serum calcium,serumphosphorus,serum IPTH were all up to the standard in 16 cases(6.25%) only.By multi factor Logistic regression analysis,the riskfactors of hyperphosphatemia were creatinine level and TG before hemodialysis.The risk factors of high IPTH were hemodialysisage,hyperphosphatemia and hypocalcemia.After strengthening managemen,the compliance rate respectively was 57.8% of serumcalcium,59.38% of serum phosphorus and 33.2% of serum IPTH,the compliance rate of all three indexes was 14.8%.Conclusion:CKD-MBD was common in maintenance hemodialysis patients,the levels of calcium,phosphorus and IPTH were affected by manyfactors.Strengthening management can improve the compliance rate of CKD-MBD indicators.