Clinical Study Of Vitamin D In The Improving Renal Anemia In Maintenance Hemodialysis Patients

Objective:To observe the efficacy of active vitamin D3 in the treatment of renal anemia in patients with maintenance hemodialysis(MHD)and analyze the related factors.Methods:Anemia patients on maintenance dialysis(serum 25(OH)D3 ≤ 30ng/m L)in hemodialysis Center of The Affiliated Hospital of Guizhou Medical University and The Affiliated Baiyun Hospital were selected as the study subjects.A total of 34 patients who met the inclusion and exclusion criteria were selected and treated with calcitriol 0.25ug/day for 12 weeks on the basis of the original treatment regimen and unchanged nutritional conditions.Clinical data,bloodroutine and biochemical indexes of patients before and after treatment were collected.Hemoglobin(Hb),red blood cell count(RBC),hematocrit(Hct),serum albumin(Alb),triglyceride(TC),calcium(Ca2+),phosphorus(P3-),C-reactive protein(CRP),serum iron(SI),total iron binding ability(TIBC),ferritin(SF),transferrinsaturation(TSAT)and parathyroid hormone(PTH)levels were compalated before and after treatment.Finally,statistical methods were used to analyze the therapeutic effect of vitamin D3 on renal anemia in dialysis patients and observe the relationship between serum vitamin D3 and related factors.Results:Among the patients enrolled in this study,the primary disease was chronic glomerulonephritis(44%),diabetic nephropathy(35%),hypertensive nephropathy(3%),polycystic kidney disease(6%),and obstructive nephropathy(12%).Pearson correlation analysis showed that vitamin D3 levels were positively correlated with serum Hb and SF levels(r=0.939,0.968;P<0.05),was negatively correlated with EHRI and CRP levels(r=-0.942,-0.882;P<0.05).Multiple linear regression analysis showed that vitamin D3 was independently correlated with Hb,SF and EHRI(P<0.05).After treatment,the level of vitamin D3 in patients was significantly higher than that before treatment,with significant statistical difference(P<0.001);CRP level was significantly lower than before treatment,with statistical difference(P<0.05);the levels of Hb,RBC,Hct,SI,SF,Alb,Ca2+ and P3-were higher than those before treatment,with no statistical difference(P>0.05).After treatment,EHRI,PTH and TC of patients decreased compared with before treatment,and there was no statistical difference(P>0.05).Patients were further divided into vitamin D3 deficiency group(25(OH)D3≤15ng/m L)and vitamin D3 deficiency group(15ng/m L<25(OH)D3≤30ng/m L).It was found that Hb level in vitamin D3 deficiency group increased significantly after treatment compared with before treatment(P<0.05),EHRI decreased compared with before treatment,the difference was statistically significant(P<0.05).In the vitamin D3 deficient group,although Hb was increased after treatment,EHRI level was decreased compared with before treatment,but there was no statistical difference(P>0.05).Conclusions:Vitamin D3 was independently correlated with Hb,SF and EHRI.To a certain extent,the application of vitamin D3 can improve the anemia of MHD patients,reduce erythropoietin resistance,improve the quality of life,and improve the long-term prognosis.