滁州市维持性血液透析患者矿物质和骨异常现状调查

Mineral and bone disorder of maintenance hemodialysis patients in Chuzhou

目的了解滁州地区维持性血液透析（maintenance hemodialysis，MHD）患者的矿物质和骨异常（mineral and bonedisorder，MBD）现状。方法调查2014年4～6月滁州地区7家医院血液透析中心的MHD患者情况。调查内容包括患者一般人口学特征、实验室检查、临床表现及用药情况等。分别以。肾脏疾病患者生存质量指导（Kidney Disease Outcomes Quality Initiative，KDOQI）和改善全球肾脏病预后组织（Kidney Disease：Improving Global Outcomes，KDIGO）指南为标准，观察血校正钙、血磷、全段甲状旁腺素（immunoreactive parathyroid hormone，iPTH）达标情况，将其达标率与透析预后和实践模式研究（the dialysis outcomes and practice patterns study，DOPPS）4比较；并比较三级医院与二级医院MHD者血校正钙、血磷、iPTH达标率。结果①入选病例1021例，平均透析时间（46．6±37．3）月。原发病前3位是慢性肾小球肾炎（512例，占50．1％）、糖尿病肾脏疾病（206例，占20．2％）、高血压肾病（144例，占14．1％）。②以KDOQI指南为标准，滁州市MHD者血校正钙、磷、iPTH达标率分别为40．5％、37．4％、21．3％，低于DOPPS4的56．7％、52．6％、29．6％（均P〈0．01）。③以KDIGO指南为标准，上述指标达标率分别为51．5％、19．8％、46．2％。④以KDOQI指南为标准，三级医院患者血磷、血iPTH达标率高于二级医院（P〈0.05），而血校正钙达标率两者差异无统计学意义。⑤MBD治疗状况：以KDIGO指南为标准，低钙、高磷和继发性甲状旁腺功能亢进的不当治疗分别占47．5％、47．6％、32．5％。结论滁州地区MHD者血钙、血磷及iPTH达标率低。三级医院MHD患者MBD控制情况较二级医院好，加强检测和管理有望提高相关指标的达标率。

Objective To understand the mineral and bone disorder （MBD） status of the main- tenance hemodialysis （MHD） patients in Chuzhou. Methods The MHD patients were investigated in hemodialysis centers of 7 hospitals in Chuzhou from April 2014 to June 2014. Study data included gen- eral demographic characteristics, laboratory examination, clinical manifestation and medications, etc. Taking KDOQI and KDIGO guidelines as standard respectively, success rate of adjusted serum calcium, phosphorus, and intact parathyroid hormone （iPTH） was observed, and then compared with the dialysis outcomes and practice patterns study （DOPPS4）. At last, success rate of adjusted serum calcium, phosphorus, and iPTH in patients with MHD was compared in hospitals of various grades. Resuits （1） Among the selected 1021 cases, 598 cases were male and 423 cases female. Mean age in patients was （56. 8±17. 3） years old and the average dialysis time was （46. 6±37. 3） months. The top three original diseases were chronic glomerulonephritis （50.1%）, diabetic nephropathy （20. 2%） and hypertensive nephrosclerosis （14. 1%）. （2） Based on KDOQI guidelines, the control rate of adjusted serum calcium, serum phosphorus, and iPTH in MHD patients was 40. 5%, 37. 4% and 21.3%, which was lower than that based on DOPPS4 （56. 7%, 52. 6% and 29. 6%） （all P〈0. 01）. （3） On the basis of KDIGO guidelines, the control rate of adjusted serum calcium, serum phosphorus, and iPTH in MHD patients was 51.5%, 19. 8% and 46. 2% respectively. （4） By comparing hospitals of various grades on the basis of KDOQI guidelines, we found that the control rate of serum phosphorus and iPTH in patients admitted to tertiary hospitals was higher than to secondary hospitals （P〈0. 05）, while the control rate of adjusted serum calcium had no obvious difference. （5） The treatment situation of MBD： On the basis of KDIGO guidelines, the inappropriate treatment of low serum calcium, hyperphosphatemia and secondary hyperparathyroidism accounted for 47. 5%, 47. 6% and 32.5% respectively. Conclusions The control rate of serum calcium, phosphorus and iPTH in MHD patients of Chuzhou is very low. MHD patients in tertiary hospitals have more ideal control situation than secondary hospitals, indicating that close monitoring and management are expected to improve the success rate.