| Objective(s):To investigate 25-hydroxyvitamin D [25(OH)D] levels in maintenance hemodialysis(MHD)patients and its correlation with neutrophil/lymphocyte(NLR)and nephrogenic anemia,to provide early intervention treatment for MHD patients with insufficient or deficient 25(OH)D levels,to provide more clinical diagnosis and treatment for MHD patients with combined nephrogenic anemia,and to slow down MHD patients This study will provide more clinical diagnosis and treatment for patients with MHD combined with renal anemia,and will be of great significance in slowing down the disease progression and improving the survival quality of MHD patients.Methods: One hundred and eight patients with chronic kidney disease who were regularly treated with MHD at the hemodialysis center of the Fifth Affiliated Hospital of Kunming Medical University from January 2018 to February 2022 were selected as study subjects,including 66 males and 42 females,who were divided into25(OH)D normal group(group I n=33),25(OH)D deficient group(group Ⅱ n= 42),and 25(OH)D deficient group(group Ⅲ n=33),and the study subjects’ gender,age,dialysis age,underlying renal disease,height,weight,body mass index(BMI),25(OH)D,absolute neutrophil value,absolute lymphocyte value,erythrocyte pressure product,hemoglobin(Hb),ferritin(Ferr),ultrasensitive C-reactive The doses of erythropoietin in the enrolled subjects were counted,and NLR and Erythropoietin Resistance Index(EHRI)were calculated.Pearson or Spearson correlation coefficients were applied to analyze the correlation between 25(OH)D levels and Hb,Ferr,EHRI,erythropoietin pressure,NLR,hs-CRP,plot the subject operating characteristic(ROC)curve,derive the area under the curve,calculate the maximum of Jorden index,and explore the predictive value of NLR,hs-CRP in MHD patients for25(OH)D deficiency,deficiency,and the predictive value of 25(OH)D levels on renal anemia.Results:1.Only 30.19% of MHD patients had normal 25(OH)D levels and 69.44% had insufficient or deficient 25(OH)D levels,of which 38.68% had insufficient 25(OH)D levels and 31.13% had deficient 25(OH)D levels.2.the mean values of NLR of patients in groups Ⅰ,Ⅱ and Ⅲ were: 3.74±1.46,4.74±3.81 and 5.61±2.99,respectively.the differences were statistically significant when comparing the NLR levels of patients in the three groups(P=0.045).the mean values of ultrasensitive C-reactive protein of patients in groups Ⅰ,Ⅱ and Ⅲ were:(3.74±1.46)mg/L,(4.74±3.81)mg/L,(5.61±2.99)mg/L.The differences were statistically significant when comparing the hypersensitivity C-reactive protein levels of patients in the three groups(P=0.000).3.the mean values of erythrocyte pressure in patients in groups Ⅰ,Ⅱ and Ⅲ were29.08±5.59,30.32±5.33and29.97±5.44,respectively.the differences were not statistically significant when comparing the levels of erythrocyte pressure in the three groups(P=0.613).the mean values of hemoglobin in groups Ⅰ,Ⅱ and Ⅲ were(100.85±18.56)g/L,(94.95±18.11)g/L,(88.70±18.37)g/L,and the differences were statistically significant when comparing the hemoglobin levels of patients in the three groups(P=0.030).the median ferritin levels in groups Ⅰ,Ⅱ,and Ⅲ were364.00(180.00-562.00)ng/ml,The mean values of erythropoietin resistance index in groups Ⅰ,Ⅱ and Ⅲ were(12.89 ± 7.62)IU/(w·kg·g·dl),(15.60 ±10.16)IU/(w·kg·g·dl),(20.81±11.97)IU/(w·kg·g·dl),respectively,and the differences were statistically significant when comparing the erythropoietin resistance index levels in the three groups(P=0.006).4.Pearson correlation analysis yielded a positive correlation between 25(OH)D levels and hemoglobin(r=0.368,P=0.000);Spearson correlation analysis yielded a positive correlation between 25(OH)D levels and ferritin(r=0.304,P=0.01);Pearson correlation analysis yielded a positive correlation between 25(OH)D levels and NLR,ultrasensitive C-reactive protein,and erythropoietin response index were negatively correlated(r=-0.354,-0.465,-0.384,P =0.000).5.To quantitatively assess the predictive value of ultrasensitive C-reactive protein for 25(OH)D deficiency or insufficiency,ROC curves were plotted with an area under the ROC curve of 0.806 and a maximum of the Yordon index of 0.604,which corresponded to a critical value of 8.33 ng/ml of ultrasensitive C-reactive protein level with a sensitivity of 0.697 and a specificity of 0.907.6.To quantitatively assess the predictive value of NLR for 25(OH)D deficiency or insufficiency,the ROC curve was plotted,and the area under the ROC curve was0.682 with a maximum Jorden index of 0.386,which corresponded to a critical value of 3.385 for NLR level,a sensitivity of 0.879,and a specificity of 0.507.7.To quantitatively assess the predictive value of NLR combined with ultrasensitive C-reactive protein for 25(OH)D deficiency or insufficiency,the ROC curve was plotted,and the area under the ROC curve was 0.720,the Jorden index was0.459 at the maximum,and its corresponding critical value for NLR combined with ultrasensitive C-reactive protein level was 0.730,the sensitivity was 0.520,and the specificity was 0.939.8.To quantitatively assess the predictive value of 25(OH)D level on the severity of nephrogenic anemia,ROC curves were plotted,and the area under the ROC curve was 0.607,the Jorden index was 0.264 at its maximum,and its corresponding critical value of 25(OH)D was 24.75 ng/ml,with a sensitivity of 0.541 and a specificity of0.723.Conclusion(s):1.Patients with MHD have a high percentage of deficient or insufficient25(OH)D levels.2.25(OH)D levels in patients with MHD were positively correlated with ferritin levels and hemoglobin levels,and negatively correlated with ultrasensitive C-reactive protein levels,NLR levels,and EHRI levels.3.The ultrasensitive C-reactive protein level,NLR level and the combination of the two were valuable in predicting the deficiency or lack of 25(OH)D level.4.25(OH)D deficiency or insufficiency had some predictive value for the degree of renal anemia. |
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