Study On Correlation Between Disturbance Of Calcium And Phosphorus Metabolism And The Ratio Of Inflammatory Cells In Peripheral Blood In Non-dialysis CKD

Objective:To analyze the changes of calcium and phosphorus metabolism and the ratio of inflammatory cells in peripheral blood in different stages of non-dialysis chronic kidney disease（CKD）,to analyze the correlation between disturbance of calcium and phosphorus metabolism and the ratio of inflammatory cells in peripheral blood in non-dialysis CKD,to explore whether the new microinflammation index-the ratio of inflammatory cells in peripheral blood including neutrophil-to-lymphocyte ratio（NLR）,platelet-to-lymphocyte ratio（PLR）,systemic immune-inflammation index（SII）can be used to predict calcium and phosphorus metabolism disorder in ND-CKD patients.Methods:181 patients with non-dialysis CKD who were hospitalized in the Department of Nephrology,China-Japan Union Hospital from March 2017 to August 2018 were selected.Their sociodemographic data,disease-related data and laboratory data including routine analysis of blood,biochemical test and PTH were collected.After calculated the numerical value of eGFR of these patients,we divided them into five groups:CKD G1,CKD G2,CKD G3,CKD G4,and CKD G5 according to the CKD staging criteria,which is set according to the numerical value of eGFR.One-way ANOVA and nonparametric tests were used to compare data mentioned above in the five groups of patients.According to the reference range of laboratory data in our laboratory,we compared the proportion of patients with hypocalcemia,hyperphosphatemia,high PTH level in blood in the five groups.We depicted the trend of NLR、PLR、SII in these five groups according to their median.Spearman-test was used to find the correlation between PLR,NLR,SII and renal function indexes including eGFR,Scr and BUN.We also measured the correlation of CSCa,P,CSCa·P,PTH with NLR,PLR,SII and other biochemical indicators in all patients through Spearman-test.The effect of NLR on CSCa,P,CSCa·P and PTH in all patients were analyzed by linear regression of one-variable.Results:1.There were statistically significant differences in gender,age,BMI,systolic blood pressure and diastolic blood pressure among the five groups（P<0.05）,there was no statistically significant difference in smoking history and drinking history（P>0.05）.The differences of eGFR,Scr,BUN,CSCa,P,CSCa·P,CO₂CP,PTH,PLT,LYM,NLR,Hb,ALB,FBG and TG in the five groups were statistically significant（P<0.05）,there was no statistically significant difference in SUA、WBC、Neu、PLR、SII、ALP、PALB、TC、LDL-C、HDL-C in the five groups.2.Patients tend to suffer hypocalcemia,hyperphosphatemia,high PTH level in blood in each stage of CKD.The proportion of patients with hyperphosphatemia,high PTH level in blood in CKD G1 was higher than that in CKD G2.The proportion of hyperphosphatemia,high PTH level in blood in CKD G2-CKD G5 gradually increased.There was no patients with hypocalcemia in CKD G1 and CKD G2,and the proportion of patients with hypocalcemia in CKD G3-CKD G5 gradually increased.3.The median of NLR in CKD G1-CKD G5showed an upward trend,and the median pf PLR did not increase or decrease.The median of SII in CKD G1-G4 increased.4.The correlation between NLR and eGFR,Scr and BUN was statistically significant（P<0.01）,and the correlation between NLR and eGFR was negative,and the correlation between NLR and Scr and BUN was positive.There was no significant correlation between PLR and SII and eGFR,Scr and BUN（P>0.05）.5.The correlations between CSCa,P,CSCa·P,PTH and NLR were statistically significant,and CSCa was negatively correlated with NLR.P,CSCa·P and PTH were positively correlated with NLR.There was no significant difference in the correlation between CSCa,P,CSCa·P,PTH and PLR and SII（P>0.05）.The correlations between CSCa,P,CSCa·P,PTH and eGFR were statistically significant（P<0.01）.The correlation between CSCa and eGFR was negative.The correlation between P,CSCa·P,PTH and eGFR was positive.The coefficient differs as follow:PTH>P>CSCa·P>CSCa.The correlations between CSCa,P,CSCa·P,PTH and BUN,CO₂CP,LYM and Hb were statistically significant（P<0.01）.The correlations between P,CSCa·P,PTH and SUA were statistically significant（P<0.05）.6.NLR affected CSCa,P,CSCa·P,and PTH.For each unit of NLR increased,CSCa decreased by 0.022 units,P increased by 0.08 units,CSCa·P increased by 1.608 units,and PTH increased by 14.146 units.Conclusions:1.P and PTH abnormalities existed in all stages of CKD patients.The abnormal proportion of P and PTH increased gradually from CKD G1 to CKD G4,CSCa appears abnormality in CKD G3,and the abnormal proportion of CSCa from CKD G3to CKD G5 gradually increased.CSCa,P,CSCa·P,PTH and eGFR were statistically correlated,and the correlation coefficient was PTH>P>CSCa·P>CSCa.2.NLR was gradually increased in patients from CKD G1 to CKD G5,and NLR was negatively correlated with eGFR.However,PLR,SII and eGFR were not statistically correlated.3.CSCa was negatively correlated with NLR in patients with undialysis CKD,and P,CSCa·P,PTH were positively correlated with NLR.NLR can be used as a predictor of undialysis of disturbance of calcium and phosphorus metabolism of non-dialysis CKD.4.CSCa was positively correlated with Hb in patients with undialysis CKD.P,CSCa·P and PTH were negatively correlated with Hb and positively correlated with SUA.