血液透析肾病患者血肌酐水平与钙磷代谢的关系

Relationship between serum creatinine level and calcium and phosphorus metabolism in patients with hemodialysis nephropathy

目的:研究血液透析(MHD)患者血清白蛋白、血红蛋白及血肌酐水平与其钙磷代谢的关系。方法:将我院收治的185例MHD患者纳为研究对象,统计其钙磷代谢异常情况,并分析钙磷代谢异常的相关危险因素。结果:185例MHD患者中,血磷达标率为51.89%,血钙达标率为64.32%,iPTH达标率为34.59%;分别以血磷、血钙及iPTH为连续变量,以年龄、CKD病程、透析时间、血磷、血钙、iPTH、钙磷乘积、TG、HDL、LDL、Hb、ALB、透析前SCr、透析前BUN等为自变量,行多因素回归分析提示,iPTH、ALB、透析前SCr及BUN水平是影响患者血磷水平的相关参数;透析时间、Hb及ALB水平是影响患者血校正钙水平的相关参数;年龄、血磷、Hb及透析前SCr水平是影响患者iPTH水平的相关参数。结论:行MHD治疗患者钙磷代谢异常发生率高,其中iPTH达标率最低,钙磷代谢紊乱将增加患者疾病负担及死亡风险,而严格限制患者蛋白质、钙元素的摄入,选择合适的磷结合剂,严格筛查可能增强钙磷代谢紊乱风险的相关因素,如年龄、透析年限等,在控制钙磷水平中具有积极意义。

Objective:To analyze the serum albumin,hemoglobin and blood creatinine levels in maintenance hemodialysis(MHD)patients and their relationship with calcium⁃phosphate metabolism.Methods:185 MHD patients in our hospital from October 2020 to March 2022 were enrolled,and the abnormal metabolism of calcium and phosphorus was analyzed,and the related risk factors were analyzed.Results:①Among 185 MHD patients,the compliance rate of serum phosphorus,calcium and iPTH was 51.89%,64.32%and 34.59%,respectively;②Serum phosphorus,serum calcium and iPTH were used as continuous variables,and age,CKD course,dialysis time,serum phosphorus,serum calcium,iPTH,product of calcium and phosphorus,TG,HDL,LDL,Hb,ALB,pre⁃dialysis SCr,and pre⁃dialysis BUN were used as independent variables.Multivariate regression analysis showed that iPTH,ALB,pre⁃dialysis SCr and BUN levels were the related parameters affecting the serum phosphorus level;dialysis time,Hb and ALB levels were the related parameters influencing the serum calcium level;age,blood phosphorus,Hb and pre⁃dialysis SCr level were related parameters influencing iPTH level.Conclusion:MHD patients suffer high risk of of abnormal calcium and phosphorus metabolism,among which iPTH has the lowest compliance rate,while,measures include strict restriction of protein and calcium intake,appropriate phosphorus binders selection,and strict screening of related factors such as age and dialysis years that may increase the risk of calcium and phosphorus metabolic disorders are of vital importance.