| BackgroundChronic kidney disease(CKD)is an important public health medical problem faced by all countries in the world.Its incidence and prevalence are high,and even in recent years,the prevalence of chronic kidney disease is still rising.The concept of chronic kidney disease-mineral and bone disorder(CKD-MBD)was put forward more than ten years ago.The 2005 KDIGO(International Organization for the Improvement of Kidney Disease)was initiated in Madrid.The symposium on renal bone disease that the concept of renal bone disease or renal malnutrition has been unable to fully reflect the characteristics of the pathophysiological changes in this group of clinical syndromes,and recommended the name CKD-MBD,while proposing specific concepts and definition[3].CKD-MBD is a generalized clinical syndrome.It refers to a systemic disease syndrome caused by abnormal mineral and bone metabolism caused by CKD.It may have one or more of the following manifestations:(1)Calcium,phosphorus,and parathyroid glands abnormalities of hormones or vitamin D metabolism;(2)Bone turnover,bone mineralization,bone mass,bone linear growth or abnormal bone strength;(3)Cardiovascular and other soft tissue calcification.CKD eventually develops into end stage renal disease(ESRD).When glomerular filtration rate(GFR)is less than 10 ml/min/1.73 m~2 and there is uremia performance,appropriate choice should be made.Kidney replacement therapy.Hemodialysis(HD)and peritoneal dialysis(PD)are currently the main alternative renal treatments.DOPPS,CORES,etc.conducted a series of large-scale clinical studies and found that CKD-MBD patients with serum phosphorus,serum calcium,parathyroid hormone(iPTH)and other indicators are too high,too low will increase the CKD patients all-cause mortality and cardiovascular and cerebrovascular disease Mortality reduces the quality of life in patients with CKD.At present,China still lacks the epidemiological survey data of patients with CKD-MBD.Even the nephrologists do not have a thorough understanding of the manifestations,clinical features,and outcomes of CKD-MBD patients in China.Many hospitals have not yet performed clinical tests for iPTH,fibroblast growth factor-23(FGF-23),vitamin D,etc.Some routine tests include calcium,phosphorus,parathyroid hormone(PTH),alkaline phosphatase,etc.Even if it is carried out,there is widespread incompleteness.Due to the progress of CKD,not only the above indicators must be detected,but also dynamic monitoring and regular monitoring must be required.If suitable and appropriate monitoring frequency can be used according to CKD stage,treatment measures,etc.,then the condition can be judged more accurately,and further guidance can be given.Treatment,make scientific management.Compared with Europe and the United States,the level of CKD-MBD treatment in China still needs to be improved.Of course,there are some unmanageable factors,especially if the related therapeutic drugs are listed late or are ready to be introduced,and most of these drugs are expensive,making China CKD-MBD treatment rate and treatment compliance rate is much lower than that of Europe and the United States.After many long-term discussions,the currently accepted basic principles of CKD-MBD treatment are:lowering blood phosphorus,maintaining the normal range of serum calcium,controlling secondary hyperparathyroidism,and preventing vascular and ectopic soft tissue calcification.However,the actual clinical situation is often much more complicated,because CKD patients often have the same conditions.With the progress of the disease and therapeutic intervention,the main contradictory relationship of the above situations will also change.Therefore,the majority of nephrotic medical workers should comprehensively evaluate the patient’s condition,body nutritional status,calcium and phosphorus standards and family economic conditions and other factors,guide patients to choose the appropriate treatment,develop individualized treatment plan,strive to not only extend the patient at the same time as life,it also improves its quality of life and thus extends its life cycle.PurposeThe purpose of this study was to analyze the clinical data of maintenance hemodialysis(MHD)patients at the Blood Purification Center of Guangzhou First People’s Hospital retrospectively to understand how the serum calcium and phosphorus standards of the MHD patients met the standard and different levels of serum phosphorus and MHD.The patient’s nutritional status and survival prognosis hope to gain some inspiration from the research results,so as to improve and improve the ability of the center and the majority of nephrotic medical workers to manage calcium phosphate and phosphate disorders and nutritional management in patients with MHD,and further master the appropriate blood phosphorus.Intervention methods ultimately improve the prognosis and quality of life of MHD patients.MethodFrom January 1,2014 to December 31,2016,149 patients undergoing hemodialysis treatment at the Blood Purification Center of Guangzhou First People’s Hospital Affiliated to Guangzhou Medical University aged 18 years old and above and maintaining hemodialysis were tracked.Observed until March 31,2018,each patient was examined every 3-6 months to measure blood phosphorus,serum calcium,blood iPTH,hemoglobin(Hb),serum albumin(Albmin,Alb),etc.,And measure body height,body weight to calculate body mass index(Body mass index,BMI),at least 6 times,and then take the average.According to the determination of serum phosphorus levels,the values were divided into three groups:hypophosphatemic group(phosphorus levels<1.13 mmol/L);methamphetamine group(1.13 mmol/L≤serum phosphorus levels≤1.78 mmol/L)and hyperphosphatemia Group(blood phosphorus levels>1.78 mmol/L).The statistical methods were used to retrospectively analyze the mortality,blood total calcium,iPTH,partial nutrition indicators,anemia compliance,age,and dialysis age of the above three groups of patients.Logistic regression was used to analyze the risk factors associated with death.Results1.The basic data of three groups of patients:The overall compliance rate of 149MHD patients in the center was 49.7%for serum phosphorus,59.7%for serum calcium,69.8%for iPTH,55.0%for Hb,73.8%for Alb,and 73.8%for BMI.The simultaneous compliance rate of blood calcium,phosphorus and blood iPTH was 16.8%(25 cases/149cases).2.The mortality rate of the three groups was 13.5%in the standard phosphorus group and 25.0%in the low phosphorus group,but there was no significant difference between the two groups(P=0.684>0.05).The high phosphorus group was 14.9%.The Alb compliance rate of the three groups of patients was highest in the low phosphorus group(25.0%),lowest in the standard phosphorus group(16.2%),and high in the high phosphorus group(20.9%),but there was no significant difference compared with the standard phosphorus group(P=0.698>0.05).).The BMI compliance rate of the three groups was 80.6%in the high-phosphorus group and 50.0%in the low-phosphorus group.There was no statistically significant difference from the standard phosphorus group(70.3%)(P=0.109>0.05).3.Analysis of hyperphosphatemia,malnutrition,and death-related factors:univariate logistic analysis of age,dialysis age,gender,serum calcium,serum phosphorus,iPTH,Hb,Alb,BMI,etc.Only age and iPTH were found to be associated with death.The difference was statistically significant(P<0.05).Multivariate logistic analysis revealed that only age was related to death,and the difference was statistically significant(P<0.05).Conclusion1.The incidence of calcium and phosphorus metabolism and the incidence of malnutrition in patients with MHD are high.2.Pure calcium and phosphorus metabolism and nutritional status point of view,blood phosphorus target is not the best;3.Suggest that in patients with MHD,blood phosphorus control method should emphasize the combination of drug phosphorus reduction and full hemodialysis,diet control and nutritional status take into account,namely the use of"3D"mode(Drugs,Dialysis,Dietary)comprehensive treatment,calcium phosphorus metabolism and nutritional indicators at the same time meet the standard more benefit for patients with MHD. |
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