温州地区维持性血液透析患者矿物质代谢紊乱情况调查

Survey on mineral and bone metabolic disturbance in patients with maintenance hemodialysis

目的了解温州地区维持性血液透析患者矿物质代谢紊乱情况及相关影响因素。方法收集2013年在温州地区长期维持性血液透析患者血钙、血磷、全段甲状旁腺激素(iPTH)的资料,并根据美国肾脏病协会指南(KDOQI)及中华医学会肾脏病学分会(CSN)制订的《慢性肾脏病矿物质和骨异常诊治指导》计算患者的血钙、血磷、iPTH的达标率,并对相关影响因素进行分析。结果共收集2 227例2013年在温州地区各家透析中心维持性血液透析患者的资料。按KDOQI指南标准,患者血钙、血磷、iPTH的达标率分别为44.90%、46.30%、27.64%,3项均达标者占6.29%;按《慢性肾脏病矿物质和骨异常诊治指导》建议,患者血钙、血磷、iPTH的达标率分别为57.66%、46.30%、61.14%,3项均达标者占16.97%。此外,三级医院维持性血液透析患者的平均血磷水平为(1.67±0.51)mmol/L,血磷达标率49.10%,二级医院患者的平均血磷水平为(1.79±0.53)mmol/L,达标率为43.22%,三级医院维持性血液透析患者的血磷达标率情况优于二级医院。血白蛋白、含钙磷结合剂的使用及透析频率是影响血钙达标的独立相关因素。患者的性别、年龄、活性维生素D的使用、透析龄及透析频率是影响血磷达标的独立相关因素。患者活性维生素D的使用是影响iPTH达标的独立相关因素。结论温州地区维持性血液透析患者矿物质代谢紊乱纠正情况与有关指南的要求仍然存在较大差距;患者性别、营养状态、透析频率、含钙磷结合剂的服用、活性维生素D的使用等是影响维持性血液透析患者矿物质代谢紊乱纠正的主要相关因素。

Objective To survey the mineral and bone metabolic disturbance and related risk factors in patients with maintenance hemodialysis （MHD）. Methods Clinical data of 2227 MHD patients from different dialysis centers in Wenzhou area were collected in 2013. The compliance rate of serum calcium, phosphorus, iPTH was assessed according to US National Kidney Foundation KDOQI guideline for CKD-MBD and Chinese Society of Nephrology （CSN） guidance and the related risk factors were analyzed. Results The compliance rates of serum calcium, phosphorus and iPTH were 44.90%, 46.30% and 27.64% respectively, according to KDOQI guideline; and the compliance rate of three items was 6.29%. The compliance rates of serum calcium, phosphorus and iPTH were 57.66%, 46.30% and 61.14% respectively, according to CSN guidance; and the compliance rate of three items was 16.97%. The compliance rate of serum phosphorus in patients aged over 60 y was higher than that of other age groups. The mean value of serum phosphorus in tertiary hospitals were lower than that in secondary hospitals （1.67 ±0.51mmol/L, 1.79 ± 0.53mmol/L）, and the compliance rate of serum phosphorus was higher （49.10%, 43.22%）. The level of serum albumin, calcium-based phosphate binders intake, frequency of dialysis were related factors influencing compliance rate of serum calcium. Sex, age, active vitamin D intake, frequency of dialysis and dialysis duration were related factors for compliance rate of serum phosphporus. Active vitamin D intake was related factor for compliance rate of serum iPTH. Conclusion The management of serum calcium, phosphorus and iPTH for MHD patients seems to be not optimistic in different dialysis centers in Wenzhou area. Sex, nutritional status, frequency of dialysis, calcium-based phosphate binders intake, active vitamin D intake are main risk factors of mineral and bone metabolism in MHD patients.