Risk Assessment And Health Management Strategy For Osteoarthritis In Patients With Chronic Kidney Disease Based On Propensity Score Matching

Objective:To analyze the risk factors of patients with chronic kidney disease and the changes of corresponding clinical indicators,to explore the correlation between bone mineral density and osteoarthritis,to evaluate the risk factors and the risk of onset of bone mass abnormality and osteoarthritis in patients with chronic kidney disease.By establishing a chronic kidney disease-osteoarthritis propensity score matching model,the basic principles of the propensity score matching model and the parameter estimation method of the model were clarified,and the influence of confounding factors among the groups was excluded to verify the abnormal bone mass and osteoarthritis in patients with chronic kidney disease.Risks provide a scientific basis for improving the quality of life of patients with chronic kidney disease,preventing the occurrence and development of osteoarthritis,reducing the economic burden of disease prevention and control,and strengthening disease health management.Methods:From August 2017 to October 2018,267 patients with chronic kidney disease were enrolled in the Department of Nephrology,Shanxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine,including 146 males and 121 females.According to the chronic kidney disease staging criteria,bone density grouping standard and VAS pain score quantitative level,the baseline data and related biochemical markers were analyzed.Logistic regression was used to analyze the risk factors of chronic kidney disease and the abnormal bone mass and bone and joint.The risk of inflammation.The propensity score matching model was used to correct the confounding factors in the study to determine the risk of chronic kidney disease and osteoarthritis.Results:1.Long duration of disease,elevated blood pressure,high urea,high creatinine,elevated parathyroid hormone and elevated?₂-MG concentration are risk factors for patients with chronic kidney disease(OR_disease=1.249,95%CI?1.011,2.964?,P=0.035;OR_SBP=4.224,95%CI?1.047,16.977?,P=0.043;OR_DBP=3.752,95%CI?1.039,12.526?,P=0.044;OR_BUN=3.979,95%CI?1.233,12.837?,P=0.021;OR_Cr=1.353,95%CI?1.007,3.128?,P=0.013;OR_PTH=2.765,95%CI?1.016,7.516?,P=0.046;OR_?2-MG=2.567,95%CI?1.621,4.805?,P=0.026).2.Bone density reduction may be related to age,duration of disease,SBP,alcohol consumption and dialysis time(F_age=5.365,P<0.001;F_disease=3.427,P=0.034;F_SBP=18.183,P<0.001;F_drink=8.625,P=0.013;F_lumber=11.951,P<0.001;F_hip=4.627,P=0.014),and in different types of primary nephropathy,chronic nephritis has the highest probability of osteoporosis,which is 32.14%.The lowest probability of benign small arteriosclerosis is8.11%.3.The levels of Cys-C,blood P,blood Ca,PTH and urinary?₂-MG in patients with abnormal bone mass?including osteopenia group and osteoporosis group?were significantly higher than those in normal bone group(F_Cys-C=6.224,P=0.027;F_P=5.367,P=0.043;F_Ca=6.018,P=0.032;F_PTH=5.657,P=0.039;F_?2-MG=6.957,P=0.021).The LDL in the normal group was higher than the abnormal bone mass group,and there was a significant difference?F=5.731,P=0.038?.4.Using multivariate logistic regression analysis to correct all covariates and propensity score matching analysis,it was found that the risk of abnormal bone mass increased with the aggravation of the patient's condition.The risk increased by 97%and117%respectively[OR₂=1.97,95%CI?1.02-1.71?,P<0.05;OR₃=2.17,95%CI?1.03-4.61?,P<0.05].5.There was a negative correlation between VAS score and BMD in osteoarthritis?r=-0.146,P=0.025?.The smaller the BMD value,the higher the probability of OA,the higher the VAS score?P<0.05?;and the concurrent CKD patients Clinical indicators such as Cys-C,blood P,and PTH of OA are significantly increased(F_Cys-c=10.110,P<0.001;F_P=13.508,P<0.001;F_PTH=11.850,P<0.001).6.According to the analysis of propensity score matching method,the risk of osteoarthritis increased with the severity of the patient's condition,its risk increased by78%[OR₃=1.78,95%CI?1.21-3.89?,P<0.05].Chronic kidney disease is an independent risk factor for osteoarthritis.Conclusion:Patients with chronic kidney disease are prone to abnormal bone mass and bone and joint disease,and their risk increases with the severity of the disease.Regular monitoring of patients with chronic kidney disease should be emphasized,and the risk assessment and health management of osteoarthritis in patients with chronic kidney disease should be strengthened.Recommendation:1.Establish and improve the health records of residents:CKD and OA patients and high-risk groups are planned to build chronic disease files.Indicators such as Cys-C,blood P,blood Ca,PTH,and urine?₂-MG are used as general items for health check,laying the foundation for the standardized management of CKD and OA.2.Integrate the technology and thinking of the Internet into the health management of diseases:the community builds a“Internet+Community”health management model for the carrier.This model promotes resource sharing between tertiary hospitals and primary medical institutions through the network interconnection property.Effectively connect with each other to achieve rational distribution and utilization of medical resources.3.Strengthening the health management education of diseases:Health education should not only target patients,but also include the family members of patients and other members of the rehabilitation group,so that people can understand both CKD and OA diseases and and take behavioral lifestyle.4.Psychotherapy for patients:Distracting patients'attention,promptly venting bad emotions,encouraging support from family members and peers,and conducting medical counseling by professional medical staff to improve the quality of life of patients to achieve psychological balance and improve treatment.Compliance and treatment effects.