Doctor-led intensive diet education on health-related quality of life in patients with chronic renal failure and hyperphosphatemia

BACKGROUND Secondary hyperparathyroidism,renal osteodystrophy,and cardiovascular adverse events can occur if long-term hyperphosphatemia is not corrected,leading to the adverse prognosis of patients with chronic renal failure.Besides the use of phosphorus binders,clinical control measures for hyperphosphatemia in these patients should also incorporate diet control.AIM To observe doctor-led intensive diet education effects on health-related quality of life in patients with chronic renal failure and hyperphosphatemia.METHODS We assessed 120 patients with hyperphosphatemia and chronic renal failure on hemodialysis admitted to our hospital(July 2018 to March 2020).The control group(n=60)was given routine nursing guidance,and the observation group(n=60)was given doctor-led intensive diet education.The changes in EQ-5D-3L scores,disease-related knowledge,and compliance scores before intervention and 3 and 6 mo after intervention in the two groups were recorded.The levels of serum parathyroid hormone(iPTH),calcium(Ca),phosphorus(P),calciumphosphorus product(Ca×P),serum creatinine(Scr),and blood urea nitrogen(BUN)before intervention and 3 and 6 mo after intervention in the two groups were assessed along with patient satisfaction.RESULTS There was no significant difference in blood iPTH,Ca,P,Ca×P,Scr,or BUN levels between the groups before intervention.After 3 and 6 mo of intervention,the blood iPTH,Ca,P,and Ca×P levels in the two groups decreased gradually(P<0.05),but there were no significant differences in Scr or BUN.The blood iPTH,Ca,P,and Ca×P levels in the observation group were lower than those in the control group(P<0.05).The satisfaction rate in the observation group after 3 mo was 93.33%and after 6,90.00%,which was high compared with the 80.00%and 71.67%,respectively,in the control group(P<0.05).There was no significant difference in EQ-5D-3L score between the two groups before intervention.After 3 and 6 mo of intervention,the visual analogue scale score of the two groups increased gradually(P<0.05);and the scores of action ability,self-care,daily activities,pain and discomfort,and anxiety and depression decreased gradually(P<0.05).The overall EQ-5D-3L score in the observation group was better than that in the control group(P<0.05).There was no significant difference in diseaserelated knowledge or compliance scores between the groups before intervention.After 3 and 6 mo of intervention,the scores of disease,diet,and medication knowledge and compliance in the two groups increased gradually(P<0.05).The scores of disease-related knowledge and compliance were higher in the observation group than in the control group(P<0.05).CONCLUSION Doctor-led intensive diet education can improve patient satisfaction and the quality of life in patients with chronic renal failure and hyperphosphatemia and promote low-phosphorus diet behavior.

Analysis and Nursing Health Education of Current Status of Maintenance Hemodialysis Patients with Hyperphosphatemia

Concerned about the current situation of hemodialysis patients'awareness of the problems related to dialysis complicated with hyperphosphatemia,further analyze the existing problems and causes,give targeted and individualized health education,improve the compliance of diet,medication and self-management,strengthen nurse-patient communication,establish a good nurse-patient relationship,reduce and control the incidence of hyperphosphatemia,improve patients'quality of life,and improve prognosis.

Severe Hyperphosphatemia Resulting in Acute Renal Failure and Ischemic Encephalopathy in a Patient with Infantile Leukemia

Tumor lysis syndrome (TLS), hyperleukocytosis, and disseminated intravascular coagulation (DIC) are representative oncological emergencies that overlap mutually at the beginning of therapy for aggressive leukemia. Lately recombinant urate oxidase (rUO) enables to control uric acid level and its crystallization, the most frequent risk factor for clinical TLS;therefore, hyperphosphatemia appears to be the main risk in the rUO era. We here report an infantile leukemia patient who developed severe hyperphosphatemia, resulting in acute renal failure and ischemic encephalopathy. A 9-month-old female baby was adynamic with a bulging anterior fontanel, and was diagnosed as infantile acute lymphoblastic leukemia with a mixed lineage leukemia gene rearrangement. A laboratory examination revealed leukocytosis, bicytopenia, hyperuricemia, a prolonged prothrombin time, activated partial thromboplastin time, and elevated lactate dehydrogenase level. Soon after a reduced dose of prednisolone was administered, she developed hypoxia caused by systemic inflammatory response syndrome and heart failure. Her white blood cell count decreased sharply, leading to acute renal failure due to hyperphosphatemia, which required continuous hemodiafiltration for 48 hours. Although renal function subsequently recovered, severe ischemic encephalopathy remained. She achieved morphological remission once, however, relapsed and passed away soon after. We have to pay attention to the progression of hyperphosphatemia, hyperkakemia and DIC, although hyperuricemia was controlled using rUO. Changes in electrolyte levels must be continuously monitored, and TLS, DIC and/or hyperleukocytosis should be promptly managed especially in patients who are sensitive to therapy.

Hyperphosphatemia after sodium phosphate laxatives in low risk patients:Prospective study

AIM:To establish the frequency of hyperphosphate-mia following the administration of sodium phosphate laxatives in low-risk patients. METHODS:One hundred consecutive ASAⅠ-Ⅱindividuals aged 35-74 years,who were undergoing colonic cleansing with oral sodium phosphate(OSP) before colonoscopy were recruited for this prospective study.Exclusion criteria:congestive heart failure, chronic kidney disease,diabetes,liver cirrhosis,intestinal obstruction,decreased bowel motility,increased bowel permeability,and hyperparathyroidism.The day before colonoscopy,all the participants entered a 24-h period of diet that consisted of 4 L of clear fluids with sugar or honey and 90 mL(60 g)of OSP in two 45-mL doses,5 h apart.Serum phosphate was measured before and after the administration of the laxative. RESULTS:The main demographic data(mean±SD) were:age,58.9±8.4 years;height,163.8±8.6 cm; weight,71±13 kg;body mass index,26±4;women, 66%.Serum phosphate increased from 3.74±0.56 to 5.58±1.1 mg/dL,which surpassed the normal value (2.5-4.5 mg/dL)in 87%of the patients.The highest serum phosphate was 9.6 mg/dL.Urea and creatinine remained within normal limits.Post-treatment OSP se-rum phosphate concentration correlated inversely with glomerular filtration rate(P<0.007,R 2=0.0755),total body water(P<0.001,R 2=0.156)and weight(P< 0.013,R 2=0.0635). CONCLUSION:In low-risk,well-hydrated patients, the standard dose of OSP-laxative-induced hyperphos-phatemia is related to body weight.

Lower body weight and female gender:Hyperphosphatemia risk factors after sodium phosphate preparations

Casais et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g.Our group has already described the relationship between body weight and hyperphosphatemia with these preparations,although our study was not quoted by Casais.We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight:group Ⅰconsisting of seven women with a median weight of 60 kg and group Ⅱconsisting of five men and one woman with a median weight of 119.2 kg.Group Ⅰdeveloped higher peak phosphate levels and maintained these levels above the subjects in Group Ⅱ for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight,fluid intake and total body weight.Our study demonstrated that adequate hydration does not protect against the secondary effects of hyperphosphatemia.In the study by Casais et al,66% of the study subjects were women,the correlation between serum phosphate and gender in their data also appears to be important.Women are at higher risk of acute phosphate nephropathy due to a diminished volume of distribution of the high dose of ingested phosphate.Decreased volume of distribution in women is due to diminished body weight.This is further compounded by decreased creatinine clearance in females.

综合管理模式对腹膜透析患者蛋白质能量消耗和高磷血症的影响

目的:探讨综合管理模式对腹膜透析(PD)患者蛋白质能量消耗(PEW)和高磷血症的影响。方法:选择2021年5~12月在安徽中医药大学第一附属医院肾内科接受治疗的60例PD患者为研究对象,随机分成干预组和对照组。对照组按常规护理方法进行管理。干预组由专科护师联合医、药、营养师运用综合管理模式进行干预3个月。观察对比两组患者干预前后相关知识掌握程度、蛋白质消耗、血磷、血钙、钙磷乘积、营养状况指标以及用药依从性。结果:实施综合管理模式干预后,干预组患者的相关知识掌握程度高于对照组(P<0.05),干预组的营养状况指标优于对照组(P<0.05),干预组的血磷、血钙、钙磷乘积指标优于对照组,干预组的高磷血症发生率低于对照组(P<0.05),干预组用药依从性高于对照组(P<0.05)。结论:综合管理模式可以减少PD患者PEW,降低高磷血症的发生率。

腹膜透析患者高磷血症管理的证据总结

目的系统检索、评估、总结腹膜透析(PD)患者高磷血症管理的证据。方法使用PIPOST模式确定循证问题,按照证据金字塔“6S”证据模型自上而下检索Up To Date临床顾问、BMJ最佳临床实践、国际指南协作网、Cochrane图书馆等网站、肾病专业协会中与PD患者高磷血症管理相关的临床决策、指南、证据总结、行业标准、规范、推荐实践、专家共识、meta分析、系统评价、随机对照试验。检索时限从2012年1月1日-2022年10月31日。由2名研究者独立对文献质量进行评价并提取相关证据。结果共纳入17篇文献,包括临床决策实践3篇、指南9篇、专家共识2篇、证据总结1篇、meta分析共1篇、标准操作规程1篇,共提取了24条关于PD患者高磷血症管理的证据,包括高磷血症管理原则、饮食管理、药物管理、透析管理、健康教育、随访6个方面。结论本研究总结了PD患者高磷血症管理的证据,可为临床医护人员制定PD患者高磷血症管理方案提供依据。

Overexpression of parathyroid pituitary-specific transcription factor （Pit）-I in hyperphosphatemia-induced hyperparathyroidism of chronic renal failure rats

Background Hyperphosphatemia in renal failure has been identified as a major role in the pathogenesis of hyperparathyroidism that is independent of changes in serum calcium and 1,25（OH）203. The aim of this study was to evaluate the expression of parathyroid Pit-1 in hyperphosphatemia-induced secondary hyperparathyroidism （SHPT） of chronic renal failure （CRF） rats. Methods Wistar rats with CRF induced by 5/6 nephrectomy were ramdomly fed with diet containing 1.2% inorganic phosphate （Pi, high phosphate （HP） group, n=-9） or 0.2% Pi （low phosphate （LP） group, n=9） for 10 weeks starting from the fourth week after the surgery. Another 7 nephrectomy rats with HP diet were intraperitoneally injected with phosphonoformic acid （PFA, the specific inhibitor of Pit-l, HP＋PFA group） 0.15 g/kg every other day for 10 weeks starting from HP diet. Another 6 HP rats injected with the same amount of normal saline as the control of the HP＋PFA group （HP＋saline group）. At the same time, 9 rats with sham surgery received HP diet as the controls. At the 4th week and 14th week, blood was taken for measurement of serum creatinine （SCr）, serum calcium （SCa）, serum phosphorus （SPi）, 1,25（OH）2D3 and intact parathyroid hormone （iPTH）. At the 14th week, two parathroid glands （PTGs） of each rat were removed by microsurgery, one gland for immunohistochemistry analysis of proliferating cell nuclear antigen （PCNA）, the other one for detection of Pit-1 by Western blotting, and for the measurement of Pit-1 mRNA and PTH mRNA by real-time quantitative polymerase chain reaction. Results In nephrectomy rats, high dierary phosphate induced a marked increase in serum phosphate, iPTH, PTH mRNA and PCNA parathyroid cells, accompanying Pit-1 and its mRNA in parathyroid gland increased significantly. However, serum Ca and 1,25（OH）2D3 remained unchanged. PFA decreased Pit-1 and its mRNA levels to reduce intact PTH, PTH mRNA and PCNA-positive parathyroid cells. Conclusions Expression of parathyroid Pit-1 in hyperphosphatemia-induced SHPT of CRF rats was upregulated. Pit-1 may mediate the stimulation to parathyroid gland by hyperphosphatemia.

Hyperphosphatemia-induced hyperparathyroidism in 5/6 nephrectomized rats： development of a new animal model

Background We require a stable model to understand the molecular mechanism by which isolated hyperphosphatemia induces hyperparathyroidism secondary to chronic renal failure. The present study established a rat model of hyperphosphatemia-induced secondary hyperparathyroidism in chronic renal failure. Methods Twenty-nine rats with 5/6 nephrectomy （Nx） were divided into three groups and were fed for 10 weeks on a high phosphate diet （1.2% phosphate） starting from three different post-Nx time points. Parathyroid hormone mRNA in parathyroid gland was measured by real-time PCR and parathyroid cell hyperplasia was tested by proliferating cell nuclear antigen （PCNA） assay. Results The 10 rats fed a high phosphate diet starting from the fourth week post-Nx had isolated hyperphosphatemia and excess synthesis/secretion of parathyroid hormone, and hyperplasia of the parathyroid glands were induced （r=0.86-0.97, P 〈0.001）, but the levels of serum calcium and 1,25（OH）2D3 did not change. Conclusion A rat model of hyperphosphatemia-induced secondary hyperparathyroidism in chronic renal failure was established by 5/6 Nx and 10 weeks-high phosphate diet starting from the fourth week post-Nx.

血液透析患者发生高磷血症风险预测模型的构建与评估

目的分析尿毒症患者血液透析期间发生高磷血症的危险因素,构建列线图模型,并验证模型的预测效果。方法选取2019年1月~2022年5月在三峡大学第一临床医学院(宜昌市中心人民医院)规律血液透析的患者为研究对象,收集其血液透析的临床资料,经最小绝对收缩和选择算子(Lasso)回归、十折交叉验证法获得高磷血症最佳危险预测因子子集,并采用多因素Logistic回归分析确定高磷血症的危险预测因子,建立预测模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线、C指数、校准曲线图和决策曲线分析来评估预测模型的预测能力、区分度、校准和临床实用性。结果共纳入200例血液透析患者,发生磷高磷血症166例,发生率为83%。多因素Logistic回归分析结果显示,甲状旁腺素、血肌酐、转铁蛋白饱和度为血液透析患者发生高磷血症的独立危险因素。基于以上影响因素建立列线图模型,构建的列线图预测模型预测尿毒症患者血液透析期间发生高磷血症的曲线下面积为0.824(95%CI:0.750~0.897),经内部验证C指数可达到0.784,具有良好的区分度与一致性。结论基于尿毒症患者血液透析期间发生高磷血症的危险因素建立列线图预测模型,可为临床医生评估血液透析患者高磷血症发生率提供理论依据,具有临床指导价值。

碳酸司维拉姆与醋酸钙治疗维持性血液透析伴高磷血症患者的效果比较

目的:比较碳酸司维拉姆与醋酸钙治疗维持性血液透析伴高磷血症患者的效果。方法:回顾性分析2020年1月至2022年10月该院收治的92例维持性血液透析伴高磷血症患者的临床资料,根据治疗方式的不同将其分为对照组和观察组各46例。对照组口服醋酸钙片治疗,观察组口服碳酸司维拉姆片治疗,比较两组治疗前后血磷、血钙、全段甲状旁腺激素(iPTH)水平,皮肤瘙痒评分,以及不良反应发生率。结果:治疗后,两组血磷水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,对照组血钙水平高于治疗前和观察组,差异均有统计学意义(P<0.05),观察组血钙水平与治疗前比较,差异无统计学意义(P>0.05);治疗后,两组iPTH水平均低于治疗前,但组间比较差异无统计学意义(P>0.05);治疗后,两组皮肤瘙痒评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:碳酸司维拉姆治疗维持性血液透析伴高磷血症患者效果优于醋酸钙,可降低血磷水平,减轻皮肤瘙痒症状,改善甲状旁腺功能,降低不良反应发生率,且不会升高血钙水平,安全性更好。

碳酸司维拉姆治疗维持性透析患者高磷血症的有效性、安全性分析

目的分析维持性透析患者高磷血症采用碳酸司维拉姆治疗的有效性和安全性。方法60例维持性透析高磷血症患者,采用双盲法将所有患者分为对照组和观察组,每组30例。对照组在基础治疗上给予醋酸钙片口服治疗,观察组在基础治疗上采用碳酸司维拉姆治疗。比较两组患者治疗12周后血钙、血磷、钙磷乘积、甲状旁腺激素水平以及不良反应发生情况。结果治疗12周后,观察组血钙(2.10±0.14)mmol/L、血磷(1.37±0.22)mmol/L、钙磷乘积(35.67±1.19)mg/dl、甲状旁腺激素(220.25±90.10)pg/ml均低于对照组的(2.17±0.11)mmol/L、(1.50±0.26)mmol/L、(40.36±1.18)mg/dl、(275.89±101.14)pg/ml,存在明显差异(P<0.05)。观察组不良反应发生率16.67%低于对照组的40.00%,存在明显差异(P<0.05)。结论对维持性血液透析高磷血症患者,采用碳酸司维拉姆治疗,具有一定安全性和有效性,能够实现对患者血磷水平的调节,降低不良反应发生率,值得在临床中广泛应用。

碳酸镧联合血液灌流对比碳酸镧联合血液透析滤过对降低慢性肾衰竭患者血磷和减轻皮肤瘙痒的临床疗效观察

目的探究碳酸镧联合血液灌流对比碳酸镧联合血液透析滤过在降低慢性肾衰竭患者血磷和减轻皮肤瘙痒中的应用价值。方法将江门市新会区第二人民医院在2022年5月~2023年5月期间收治的88例慢性肾衰竭并高磷血症伴皮肤瘙痒患者作为本次研究对象,通过随机数字表法获得对照组(44例,口服碳酸镧咀嚼片联合血液透析滤过治疗)与研究组(44例,口服碳酸镧咀嚼片联合血液灌流治疗),比较两组患者治疗效果、治疗前后血钙、血磷与甲状腺素,并发症发生率与皮肤瘙痒改善情况。结果与对照组治疗总有效率81.82%相比,研究组95.45%较高(P<0.05)。治疗前,两组患者血钙、血磷以及甲状腺素水平差异无统计学意义(P>0.05),治疗后,两组患者血钙水平上升,血磷与甲状腺素水平均降低,其中,与对照组相比,研究组各指标变化幅度较大(P<0.05)。和对照组相比,研究组并发症总发生率较低(13.64%vs.2.27%),皮肤瘙痒改善率较高(75.00%vs.90.91%)(P<0.05)。结论与碳酸镧联合血液透析滤过治疗相比,在慢性肾衰竭患者中应用碳酸镧联合血流灌注治疗效果较优,能够有效改善患者血钙、血磷与甲状腺素水平,提升皮肤瘙痒改善率与治疗效果。

多学科协作干预对维持性血液透析患者血磷、健康知识和遵医行为的影响

目的探讨多学科协作干预对维持性血液透析患者血磷、健康知识和遵医行为的影响。方法选择本院血液透析室2020年12月—2021年11月收治的高磷血症维持性血液透析患者共66例为对象。采用随机数字表法将患者分为观察组和对照组,每组33例。其中,对照组予以常规综合干预,观察组在此基础上予以多学科协作干预。比较两组干预前和干预3月后血磷水平、血磷控制达标率和健康知识、遵医行为评分。结果两组干预后血磷水平、蛋白质、钾、磷摄入量以及健康知识掌握评分和医嘱执行评分均较干预前显著改善,组间差异有统计学意义(P<0.05)。观察组干预后血磷水平、蛋白质、钾、磷摄入量低于对照组,血磷达标率以及健康知识掌握评分和医嘱执行评分高于对照组,差异有统计学意义(P<0.05)。结论在常规干预基础上,为高磷血症血液透析患者提供多学科综合干预,能够进一步控制血磷水平,提高血磷达标率。同时,能优化患者饮食结构,促进患者相关专业知识掌握,并提高医嘱执行力。

维持性血液透析患者高磷血症自我管理真实体验的质性研究

目的 深入了解维持性血液透析患者高磷血症自我管理的真实体验,为临床护理实践提供参考。方法 对13例维持性血液透析高磷血症患者进行半结构式访谈,采用内容分析法对资料进行编码、分析和提炼主题。结果 共提炼出身心困扰(瘙痒、无力感、自我感受负担、疾病不确定感),决策困境(血磷管理困境、希望掌控生活主动权、希望血磷控制在合理水平、基于自我感受的管理策略),转变行为(认知的积累与转变、积极自我监测、调动家庭资源、寻求医护或同伴支持)3个主题及12个亚主题。结论 维持性血液透析高磷血症患者的自我管理体验复杂,护理人员应针对其需求与体验实施针对性干预,协助患者将血磷控制在正常水平。

健康促进模型在维持性血液透析患者高磷血症护理中的应用

目的:评价健康促进模型在维持性血液透析高磷血症患者护理中的应用效果,为高磷血症临床管理实践提供参考。方法:纳入2019年7月—11月某三级甲等医院血液净化中心行维持性血液透析治疗的高磷血症患者80例。按患者透析时间分为对照组和干预组,各40例,对照组实施常规护理,干预组接受基于健康促进模型的护理干预。比较两组患者干预前后血磷管理知识行为、自我效能、血磷水平、血磷达标率及血清白蛋白水平的差异。结果:干预1个月后干预组血磷管理知识行为得分高于对照组,血磷水平低于对照组,差异有统计学意义(P<0.05);干预4个月后,干预组血磷管理知识行为得分、自我效能、血磷达标率及血清白蛋白水平高于对照组,血磷水平低于对照组,差异有统计学意义(P<0.05)。结论:基于健康促进模型的护理干预可提升维持性血液透析高磷血症患者血磷管理知识行为及自我效能,降低血磷水平并改善营养状况。

互动叙事联合PBOPPPS教育对维持性血液透析并发高磷血症病人服药依从性的影响

目的:探讨互动叙事联合PBOPPPS教育对维持性血液透析并发高磷血症病人服药依从性的影响。方法:采用便利抽样法于2020年1月—2020年12月选取某医院60例维持性血液透析并发高磷血症病人为研究对象,按非同期对照试验法分为对照组与干预组各30例,对照组实施常规服药依从性教育,干预组实施互动叙事联合PBOPPPS教育。比较两组病人干预前后的服药依从性。结果:干预后两组病人服药依从性得分较干预前均明显提高,且观察组病人提高更明显(P<0.05)。结论:互动叙事联合PBOPPPS教育能够有效提高维持性血液透析并发高磷血症病人服用磷结合剂的依从性。

维持性血液透析患者高磷血症的危险因素研究

目的通过分析山东省枣庄市立医院血液透析中心MHD患者临床资料,探讨高磷血症的相关危险因素。方法采用横断面调查方式,纳入MHD患者共152例,收集其临床资料及实验室检查结果。根据血磷水平将MHD患者分为高磷血症及非高磷血症组,采用Spearman相关性分析和logistic回归分析的方法,比较、分析2组间的检验结果。结果152例患者中,107例(70.4%)患者血磷≥1.78 mmol/L。与非高磷血症组相比,高磷血症组的MHD患者更年轻、前白蛋白、白蛋白、肌酐及尿酸等代谢指标水平更高,尿素清除指数更低(P<0.05)。应用多因素Logistic回归分析高磷血症的独立危险因素,结果提示肌酐的OR值为1.005,尿酸的OR值为1.007。结论高水平肌酐和尿酸是MHD患者高磷血症的独立危险因素。

高磷血症对腹膜透析患者认知障碍影响的研究

目的探讨持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者高磷血症与认知障碍之间的相关性。方法纳入河北医科大学第二医院肾内科2021年1月—2022年12月长期规律门诊随访的CAPD患者。采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评估患者整体认知功能;通过测试A(trail-making test forms A,TA)评估患者执行功能。采用SPSS 26.0进行统计处理。结果312例CAPD患者认知障碍患病率为36.9%。单因素相关性分析显示:高磷血症(OR=2.333,95%CI:1.456~3.736,P<0.001)、年龄(OR=0.830,95%CI:1.076~1.135,P<0.001)与整体认知功能相关。血清白蛋白(OR=0.869,95%CI:0.770~0.982,P=0.024)和年龄(OR=1.073,95%CI:1.024~1.124,P=0.003)与执行功能相关。血钙(OR=0.218,95%CI:0.048~0.999,P=0.050)、全段甲状旁腺激素(OR=1.000,95%CI:0.999~1.001,P=0.484)与整体认知功能无显著相关性。多因素回归分析结果显示:对人口学、临床及实验室混杂因素进行校正后,高磷血症仍与认知障碍相关(95%CI:3.272~17.741,P<0.001),高磷血症的CAPD患者认知障碍的发生率为非高磷血症患者的7.62倍。ROC曲线结果显示:当血磷取值为1.66时,约登指数最大值为0.30,灵敏度为75.7%,特异度为54.1%。结论在CAPD患者中,血磷水平影响患者的整体认知,高磷血症是腹膜透析患者认知障碍的独立危险因素,血磷水平大于1.66 mmol/L明显增加患者认知障碍的风险。