| Objective: To investgate the insufficient or a lack of vitamin D in patients with chronic kidney disease,and analyze the related clinical indicators..For reasonable application of vitamin D supplements,better to prevent vitamin D deficiency and lack of lead to provide basis for related complications.Methods:Selection in December 2014-July 2015,Our department in hospital diagnosis for chronic kidney disease,did not use active vitamin D treatment,history of renal failure for 4 years on average.Diagnostic criteria of CKD following the 2005K/DOQI guidelines:(1)renal damage in 3 months or more,renal damage to kidney structure or function is unusual,with or without associated with reduced glomerular filtration rate(GFR),as one of the following: pathologic abnormalities,renal damage index(including abnormal blood or urine components)or abnormal imaging examination.(2)the GFR < 60 ml/ml/(m in·1.73m2)in 3 or more months,with or without renal damage.200 patients into the study,exclusion criteria: 25(OH)D3 > 30ng/ml;Recently received vitamin D supplements treatment;Hypercalcemia(serum or greater tendency for 55 L);Severe hyperphosphatemia(blood phosphorus or greater tendency for 2 L);Severe skin disease;Any reason caused by liver damage;Primary osteoporosis.For nearly three months using hormones or immune inhibitors;Withtumor,chronic infections,diarrhea and autoimmune diseases,etc.Finally,include 49 patients,28(57.1%)of men and 21(42.9%)of the female.Average age was 52.2 ±12.4,with an average follow-up time was 84.9 ±27.4 days.Chronic kidney disease stages:Stage 1:≥90 ml/(min·1.73m2);Stage2: 60-89ml/(m in·1.73m2);Stage 3: 30-59ml/(min·1.73m2);Stage 4:15-29 ml/(min·1.73m2);Stage 5: < 15ml/(min·1.73m2).Diagnostic criteria: vitamin D levels of vitamin D deficiency: 25(OH)D3 <20 ng/ml;Vitamin D deficiency: 25(OH)D3 in 20 to 30 ng/ml;Adequate vitamin D: 25(OH)D3 > 30 ng/ml.By using enzyme linked immunosorbent assay(ELISA)determination of serum 25(OH)D levels.Clinical data collection: age,gender,weight,blood pressure,white blood,blood urea nitrogen(BUN),creatinine(Scr),uric acid(UA),total cholesterol(TC),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C)blood,blood calcium,blood phosphorus,intact parathyroid hormone(iPTH),and other indicators.Analysis of 25(OH)D3 and the relationships between the various indicators,using Pearson correlation analysis of 25(OH)D3 and the correlation of each.Difference was statistically significant(P <0.05).Results:This study of 49 patients,28(57.1%)of men and 21(42.9%)of the female.Average age was 52.2±12.4,with an average follow-up time was 84.9±27.4days.13(26.5%)patients with hypertension,the median duration of 4(0.0,9.5);Four patients(8%)had diabetes,blood sugar control during follow-up.Patients with oral before and after the basic data of calcitriol.Weight,white blood cells,albumin,bladder inhibition C,low density lipoprotein cholesterol,blood calcium in giving the results before and after the active vitamin D has no statistically significant differences(P > 0.05).Included in the study of 49 patients is in a state of vitamin D deficiency or inadequate.In the calcitriol therapy,the patients’ serum 25(OH)D3 level before and after treatment increased(18.6±4.0 vs 20.0 ±6.0 ng/ml;P < 0.05).At the end of the follow-up,2 cases(4%)patients with 25(OH)D3 level has reached normal levels(>30 ng/ml).31(63.3%)patients had 25(OH)D3 level is increased before treatment.No one reached the level of 25(OH)D3 poisoning patients(> 100 ng/ml).22(44.9%)patients with hemodialysis in oral after of calcitriol,25(OH)D3level was increased(19.4±4.2 vs 21.9±6.6;P < 0.05);Peritoneal dialysis patients(19cases accounted for 38.7%),25(OH)D3 to the rise of no statistical significance(17.8±3.9 vs 18.4±4.8;P = 0.48).8(16.3%)patients without renal replacement therapy,before and after treatment serum 25(OH)D3 has no obvious rise(18.5±3.6 vs.18.4±6.3;P = 0.99).Patients with urea,creatinine,uric acid,blood pressure,low density lipoprotein levels from the previous decreased(P < 0.05).Most of the patients to give antihypertensive,lipid adjusting treatment,such as giving ACEIs,ARBs and statins.Hemoglobin after giving active vitamin D was increased(P<0.05).High-density lipoprotein cholesterol(HDL-C)significantly increased compared with the previous(P < 0.001).Blood phosphorus and iPTH give calcitriol earlier after treatment significantly decreased(P < 0.001).During follow-up,6patients with brief high-dose intermittent shock therapy to treat secondary hyperparathyroidism.We further analyzed the minerals-bone metabolism indexes including blood calcium and blood phosphorus,25(OH)D3 concentrations of iPTH and correlation;Nutritional indices such as serum albumin,hemoglobin,total cholesterol and 25(OH)D3 concentrations of correlation.The results showed that 25(OH)D3 was positively correlated with serum albumin and hemoglobin,25(OH)D3 are negatively related to total cholesterol;And there was no significant correlation iPTH,blood calcium and blood phosphorus.Conclusion:1.Chronic kidney disease patients without dialysis,dialysis of 25(OH)D3 is insufficient and lack of a high incidence,and increases with age and progress of 25(OH)D3 renal function lacks the more serious.2.Vitamin D3 general lack of and the insufficiency in CKD,can be used vitamin D3 supplementation to correct.Suggestions on monitoring the level of blood calcium and blood phosphorus and iPTH cases,application of active vitamin D3,application does not increase blood calcium or elevated blood calcium less vitamin D analogue,shows that it has been reported in calcium phosphate concentration increase is associated with higher mortality for patients with chronic kidney disease(CKD).Patients with chronic kidney disease(CKD)associated with a port near active vitamin D3 is more suitable for application. |
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