腹膜透析患者血清钙、磷与全段甲状旁腺激素的相关因素

Related factors with serum calcium,phosphate and intact parathyroid hormone in Chinese peritoneal dialysis populations

目的慢性肾脏病矿物质与骨异常(CKD-MBD)是CKD患者的常见并发症。关于CKD-MBD的现有数据重点关注血液透析(HD)患者。关于中国腹膜透析(PD)患者中CKD-MBD的研究极少,尤其缺乏大样本对比性研究。我们希望明确与CKD-MBD相关参数有关的潜在影响因素。方法收集本单位定期PD患者的人口统计学资料。采集空腹血标本及前一天全部尿液和透析液。测定血清标本的生化全套。测定24小时尿量以及腹透液与24小时尿液中肌酐(Cr)与尿素氮(BUN)浓度。根据公式计算周Kt/V、残余肾功能(RRF)和周肌酐清除率(Ccr)。研究血清钙(Ca)、磷(P)和全段甲状旁腺激素(i PTH)的可能相关因素。结果入选140例PD患者,其中男76例,女64例。具有更好残余肾功能的患者血P控制更佳。相关性分析表明血清钙与RRF、透析时间以及SCr和白蛋白(ALB)水平显著相关;血清P与RRF、Kt/V、周Ccr、BUN、透析时间以及SCr和ALB水平显著相关;血清i PTH与RRF、周Ccr、年龄、透析时间以及SCr和ALB水平显著相关。结论本研究结果表明以RRF和24小时尿量作为残余肾功能评价指标时,具有更好残余肾功能的PD患者血清P、ALP和i PTH控制更好。因此保护残余肾功能对ESRD人群有重要意义。

Objective Chronic kidney disease mineral and bone disorder(CKD-MBD)is a common complication in CKD patients.The availabledata on CKD-MBD mainly focuses on hemodialysis(HD)patients.There are few such studies in Chinese peritoneal dialysis(PD)population,especially large scaled comparative studies.We aimed to identify possible related factors with CKD-MBD related parameters in end stage renal diseasepatients.Methods We collected demographic data of regular PD patients in our hospital.Fasting serum samples and total urine and total dialysate inthe previous24hours were collected.We measured urine volume as well as urea nitrogen and creatinine concentrations of24-hour urine and dialysatesamples,and biochemical panel of serum samples.Weekly Kt/V,residual renal function(RRF)and weekly clearance of Cr(CCr)were also calculated.Possible related factors to serum Ca,P and iPTH were investigated.Results140PD patients were enrolled,including76men and64women.Correlation analysis indicated serum cCa was significantly related to RRF,time on dialysis and the levels of SCr and ALB;serum P was significantlyrelated to RRF,Kt/V,weekly Ccr,BUN,time on dialysis and the levels of SCr and BUN;serum iPTH was significantly related to RRF,weekly Ccr,age,time on dialysis and the levels of SCr and ALB.Conclusion Our results indicated using RRF and24-hour urine volume as indicators of residualrenal function in PD population,patients with better residual renal function have better control of serum P,ALP,and iPTH.Protection of residualrenal function is of great importance for ESRD population.