慢性肾脏病中、晚期患者矿物质和骨代谢紊乱的知晓率、治疗率和控制率

The awareness rate, treatment rate and control rate of mineral and bone disorder in patientswith moderate or advanced stage chronic kidney disease

目的调查我院慢性肾脏病（CKD）中、晚期非透析和透析患者矿物质和骨代谢紊乱的知晓率、治疗率和控制率。方法选取503例CKD3期以上的非透析和透析患者，通过问卷的形式，结合实验室检查了解患者对矿物质和骨代谢紊乱的知晓率、治疗率和控制率。结果CKD中、晚期患者矿物质和骨代谢紊乱知识知晓率以血液透析患者最高，腹膜透析患者其次，非透析患者最低，差异有统计学意义（P〈0．01）。知识调查总得分显示，腹膜透析[11（9，12）]和血液透析[13（11，15）]患者显著高于非透析患者[6（5，8）]（P〈0．01）。相关知识的了解程度与年龄（r=-0．11，P〈0．05）呈负相关；与文化程度（r=0．226，P〈0．01）、肾脏病病程（r=0．597，P〈0．01）和透析龄（r=0．366，P〈0．01）呈正相关。医护人员宣教是CKD中、晚期患者获取知识的主要渠道，在非透析、腹膜透析和血液透析患者中分别占94．O％、79．5％和69．4％。腹膜透析（88．6％）和血液透析（96．9％）患者的矿物质和骨代谢紊乱治疗率均显著高于非透析患者（58．2％）（均P〈0．01）。在控制率方面，以K／DOQI指南为标准，非透析患者血钙、血磷、钙磷乘积和甲状旁腺素（PTH）等的达标率明显优于透析患者；在各项指标的达标数量上也显著优于透析患者（均P〈O．01）。以KDIGO指南为标准，非透析（46．7％）和腹膜透析（36．9％）患者的血磷达标率均显著高于血液透析患者（23．6％）（均P〈0．01）。结论CKD中、晚期非透析患者矿物质和骨代谢紊乱的知晓率和治疗率较低，控制率较高；而透析患者的知晓率和治疗率较高，但控制率较低。

Objective To investigate the awareness rate, treatment rate and control rate of mineral and bone disorder in patients with moderate or advanced stage chronic kidney disease （CKD）. Methods The awareness rate, treatment rate and control rate of mineral and bone disorder were evaluated based on a questionnaire and related laboratory examinations in 503 CKD stage 3 to 5 patients. Results The awareness rate of mineral and bone disorder in patients withmoderate or advanced stage CKD was highest in hemodialysis patients, moderate in peritoneal dialysis patients and lowest in non-dialyzed patients （all P〈0.01）. The total scores of the questionnaire were lowest in non-dialyzed patients [6 （5,8）] and were significantly higher in peritoneal dialysis [11 （9,12）] and hemodialysis patients [13 （11,15）] （P〈0.01）. The extent of awareness was negatively correlated with age （r=-0.11, P〈0.05）, and positively correlated with educational background （r=0.226, P〈0.01）, duration of CKD （r=0.597, P〈0.01） and duration of dialysis （r=0.366, P〈0.01）. The source of knowledge was mainly from publicity and education made by medical staff, which accounted for 94.0%, 79.5% and 69.4% respectively in non- dialyzed, peritoneal dialysis and hemodialysis patients. The treatment rate was significantly higher in peritoneal dialysis （88.6%） and hemodialysis patients （96.9%） than that in non-dialyzed patients （58.2%） （all P〈0.01）. According to K/DOQI guideline, the control rate of serum calcium, phosphorus, calcium and phosphorus product and parathyroid hormone （PTH） were much better in non-dialyzed patients as compared to dialyzed ones. The percentage of number of lab indicators meeting the standard was significantly higher in non-dialyzed patients as compared to dialyzed ones （P〈0.01）. According to KDIGO guideline, the control rate of serum phosphorus was significantly lower in hemodialysis patients （23.6%） than that in peritoneal dialysis （36.9%） and non-dialyzed patients （46.7%） （P〈0.01）. Conclusions In non-dialyzed patients with moderate or advanced stage CKD, the awareness rate and treatment rate of mineral and bone disorder are relatively low, and the control rate is relatively high. Whereas in dialyzed patients, the awareness rate and treatment rate are relatively high, and the control rate is relatively low.