Laboratory Investigation And Analysis Of Calcium Phosphorus Metabolism In Maintenance Hemodialysis Patients

ObjectiveTo explore the morbidity and the management of calcium phosphorus metabolism disorders in maintenance hemodialysis(MHD) patients in zhengzhou,and analyze the reasons and the related risk factors. MethodsThe target population was the 472 patients who took treatment of hemodialysis in hemodialysis center of seven tertiary hospitals in Zhengzhou during Jul.2013 to Feb.2014.We gathered the demographic information and the calcium phosphorus metabolism disorders related indicators.We divided the patients into different subgroups on the basis of different levels of serum Ca, P, i PTH.Then we analyzed the situation of reaching the standard and separately compared multiple clinical indicators among different subgroups which include sex,age,cause of the kidney disease,duration of the chronic kidney disease,duration of the hemodialysis,Hb,serum β2-MG, i PTH, phosphorus, calcium,urea nitrogen before dialysis,creatinine before dialysis,Kt/V,Alb,CHOL, TG,HDL,LDL and so on. Finally we analyzed the potential relative risk factors of the calcium phosphorus metabolism disorders by the multi-variance Logistic regression analysis. Results472 patients were evaluable for this study:Male/Female=287/185,mean age= 55.28±15.68 years,mean range of duration of CKD=76.53±75.75 months,mean range of duration of hemodialysis=29.34±26.67 months.The morbidity of hypophosphatemia, hyperphosphatemia, hypocalcemia, hypercalcinemia,low i PTH,elevated i PTH and abnormal calcium-phosphorus product were 15.5%,43.4%,23.5%,35.2%, 31.4%, 41.5% and 28.6%. The percentage of patient who achieved the recommended standard levels of serum phosphorus, albumin-corrected serum calcium, calcium-phosphorus product, i PTH were 41.1%、41.3%、71.4%、27.1%. The low level of i PTH is more prevalent in the diabetic nephropathy patients, hyperphosphatemia is more prevalent in the hypertensive nephropathy patients. Multivariants analysis revealed that possible serum phosphorus correlated parameters included age, urea nitrogen before dialysis,creatinine before dialysis, i PTH, LDL, Alb. Multivariants analysis revealed that possible albumin-corrected serum calcium correlated parameters included serum Dialysis time, LDL, Hb. Multivariants analysis revealed that possible serum i PTH correlated parameters included age, creatinine before dialysis, serum phosphorus. Multivariants analysis revealed that possible calcium-phosphorus product correlated parameters included creatinine before dialysis, age, LDL, Hb. Conclusions1. Calcium phosphorus metabolism control success rate is low, especially i PTH eligible accounted for only 27.1%.2. The low level of i PTH is more prevalent in the diabetic nephropathy patients, hyperphosphatemia is more prevalent in the hypertensive nephropathy patients.3.The risk factors are age, Dialysis time,urea nitrogen before dialysis, creatinine before dialysis,LDL, Alb, Hb.