维持性血液透析患者慢性肾脏病-矿物质与骨异常的单中心横断面研究

Single center and cross sectional study on chronic kidney disease-mineral and bone disorder in maintenance hemodialysis patients

目的了解单透析中心的维持性血液透析患者慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的发病率及控制情况。方法透析中心的126例维持性血液透析患者透析前空腹取血,检测血钙、血磷、血全段甲状旁腺激素(intact parathyroid hormone,i PTH)水平,并分析三者达标现状,与2014年上海市70家血液透析中心的平均水平比较;采用侧位腹平片了解腹主动脉钙化情况,评估血管钙化发生率;采用跟骨骨密度的超声,了解CKD-MBD伴低骨密度发生率。结果本透析中心126例患者中,符合CKD-MBD诊断标准的患者有116例,占92.0%;126例患者的血磷(2.3±3.71)mmol/L,血钙(2.23士0.33)mmol/L,i PTH(401±421)pg/ml;与2014年上海市70家透析中心的平均水平相比,本中心血钙达标率低于平均水平(35.71%比48.86%,χ2=4.188,P=0.042),血磷达标率低于平均水平(41.85%比61.36%,χ2=21.094,P<0.001);i PTH达标率明显高于平均水平(58.73%比44.91%,χ2=9.581,P<0.001);腹主动脉钙化发生率74.6%;CKD-MBD伴低骨密度发生率72.22%。结论维持性血液透析患者矿物质骨异常的发生率高,CKD-MBD伴低骨密度、血管钙化的问题严重,血钙、磷的达标率低,维持性血液透析患者人群中CKD-MBD的现状值得关注。

Objective To investigate the incidence and control of chronic kidney disease-mineral and bone disorder（CKD-MBD） in maintenance hemodialysis（MHD） patients. Method A total of 126 MHD patients in our dialysis center were recruited. Their serum calcium（Ca）, phosphorus（P） and intact parathyroid hormone（i PTH） were collected to analyze the compliance status with the required levels and to compare with the average levels of the patients in 70 hemodialysis centers in Shanghai in 2014. Calcification of abdominal aorta was evaluated by lateral plain film, and bone mineral density was measured by ultrasonic examination of the calcaneus. Results In the 126 MHD patients, 116 patients（92%） met the diagnosis criteria of CKDMBD. In the 126 MHD patients, the average levels of serum P, Ca and i PTH were 2.3±3.71 mmol/L, 2.23±0.33 mmol/L, and 401±421 pg/ml respectively. Serum P, Ca and i PTH compliant with the required levels were41.85%, 35.71% and 58.73%, respectively, of the patients, lower than the average levels of serum Ca and P and higher than the average level of serum i PTH in the patients in 70 hemodialysis centers in Shanghai in2014（35.71% vs. 48.86%, χ2=4.188, P=0.042 for serum Ca; 41.85% vs. 61.36%, χ2=21.094, P〈0.001 for serum P; 58.73% vs. 44.91%, χ2= 9.581, P〈0.001 for serum i PTH）. The prevalence of abdominal aorta calcification was 74.6%, and the prevalence of CKD- MBD with low bone mineral density was 72.22%. Conclusions CKD-MBD was prevalent in MHD patients. CKD-MBD was frequently associated with low bone density, vascular calcification, and lower compliance with the required serum Ca, P and i PTH levels. Nephrologists should pay more attention to these abnormalities in MHD patients.