海南热带地区腹膜透析慢性肾脏病矿物质和骨异常(CKD-MBD)单中心横断面研究

Cross-sectional investigation on chronic kidney diseasemineral and bone disorder in peritoneal dialysis patients in a single center from the tropical area of Hainan Province

目的了解海南热带地区腹膜透析慢性肾脏病矿物质和骨异常(CKD-MBD)患病情况,并分析相关危险因素。方法对2016年8月至2018年7月在海南医学院第二附属医院腹膜透析中心规律行腹膜透析的256例慢性肾脏病(CKD)患者矿物质和骨代谢的相关指标进行回顾性分析,并对引起血磷异常的相关因素进行多因素Logistic回归分析。结果256例腹膜透析患者中,高磷血症患病率为26.2%,低磷血症患病率为27.0%,高钙血症患病率为65.6%,低钙血症患病率为9.8%,高全段甲状旁腺素(iPTH)血症患病率为46.5%,低iPTH血症患病率为37.0%;符合KDIGO指南关于CKD-MBD诊断者248例,占96.9%;腹膜透析患者血磷、血钙、iPTH达标率分别为46.9%、24.6%、17.2%,血磷、血钙、iPTH均达标者仅8例(占3.1%);多因素Logistic回归分析显示,血肌酐水平升高和尿素氮水平升高是高磷血症的危险因素(P<0.05),CO2-CP升高是低磷血症的危险因素(P<0.05)。结论CKD-MBD在腹膜透析患者中普遍存在,腹膜透析患者血清钙、磷及iPTH控制不理想,CKD-MBD的现状值得关注。

Objective To explore the mobidity,management and risk factors of the chronic kidney disease-mineral and bone disorder(CKDMBD).Methods 256 patients receiving peritoneal dialysis in the dialysis center of the Second Affiliated Hospital of Hainan Medical University during the period of August 2016 to July 2018 were enrolled in this study.Demographic information and CKD-MBD related indicators including serum calcium,phosphorus and iPTH were collected.Multivariate Logistic regression analysis was used to identify the risk factors for serum phosphorus.Results In the 256 patients,the prevalence of hyperphosphatemia,hypophosphatemia,hypercalcemia,hypocalcemia,elevated iPTH and reduced iPTH was 26.2%,27.0%,65.6%,9.8%,46.5%,37.0%,respectively.96.9%patients met the diagnosis criteria of CKD-MBD.The percentage of patients with the recommended standard level of serum phosphorus,calcium and iPTH was 46.9%,24.6%and 17.2%,respectively.Only 8 patients(3.1%)achieved all the three recommended standard levels provided by KDIGO guidelines.Multivariate Logistic regression analyses demonstrated that the risk factors for hyperphosphatemia were the increase in serum creatinine level and BUN level and the risk factors for hypophosphatemia were the increase in CO2-CP level.Conclusion CKD-MBD is prevalent in peritoneal dialysis patients.The controlling of serum calcium phosphorus and iPTH levels in the peritoneal dialysis patients seems not to be ideal.Nephrologists should pay more attention to these abnormalities in peritoneal dialysis patients.