| Objective: To investigate the prevalence and management of the chronic kidney disease-mineral and bone disorder(CKD-MBD) in peritoneal dialysis and hemodialysis patients, and analyze its influencing factors for the effective ways of controlling.Methods: A single center cross-sectional observational study was designed. There are 448 patients on dialysis treatment for at least 3 months were enrolled during the Mar. 2013 to Mar.2015 in General Hospital of Ningxia Medical University. The study included 355 continuous ambulatory peritoneal dialysis(CAPD) patients and 93 maintenance hemodialysis(MHD) patients. The data including demographic information, biochemical items and evaluation indicators were collected. The prevalence and risk factors of CKD-MBD were analyzed in peritoneal dialysis and hemodialysis patients respectively.Results:(1) One hundred and eighty two cases of the CAPD patients were male(51.5%), the average age was(52.9±13.1) years old and the median dialysis age was 17.7(8.4,43.7) months. Among the CAPD patients, 176 cases had the major primary disease of chronic glomerulonephritis(49.6%), 76 cases of diabetic kidney diseases(21.4%) and 75 cases of hypertensive renal arteriolar sclerosis(21.1%).In the CAPD patients, 37.2% had the phosphate binder taken history and 14.9% had activated vitamin D. Fifty five cases of the MHD patients were male(59.1%), the average age was(52.1±14.4) years old and the median dialysis age was 21.1(7.9,32.7) months. Among the MHD patients, 46 cases had the major primary disease of chronic glomerulonephritis(49.5%), 18 cases of diabetic kidney diseases(19.3%) and 10 cases of hypertensive renal arteriolar sclerosis(10.8%). In the CAPD patients, 47.7% had the phosphate-binder taken history and 32.3% had activated vitamin D.(2) The control rates of serum calcium in the CAPD group and the MHD group were 65.6% and 65.6%, respectively; while those of serum phosphate and i PTH in the two groups were 50.4% vs 46.2%, and 26.4% vs 24.7%, respectively. The total control rates of serum calcium, serum phosphate and i PTH were 11.8% and 6.5%, respectively. There was no statistical differences between these two groups.(3) comparing with the DOPPS4 target in the MHD patients of developed countries, the control ratio of serum calcium serum phosphate and i PTH were 65.6% vs 56%(p=0.06),(46.2% vs 54.5%, p=0.11) and(24.7% vs 32.1%, p=0.13), respectively.(4) The incidence of hypocalcemia was remarkably higher in the CAPD group than in the MHD group(17.2%vs2.8%, p<0.01), while the incidence of hyperphosphatemia was notably higher in the MHD group than in the CAPD group(34.4%vs20.2%,p<0.01). However, the incidence of high i PTH and low i PTH showed no statistical difference in both the CAPD group and the MHD group(25.8%vs32.3%,47.8%vs43.0%,p>0.05).(5) Multivariate Logistic regression analysis indicated :(1) The advanced age as well as the long dialysis vintage of the patients were the independent risk factors of non- targeting on serum calcium of the CAPD patients. Regularly taking phosphate-binder, slowing the decline of residual renal function were the independently associated with targeting on serum phosphate. The advanced age,the long dialysis vintage of the patients and the high level of serum phosphate were the independent risk factors of non-targeting on i PTH.(2)The high level of i PTH was the independent risk factor of non- targeting on serum calcium of the MHD patients. The high level of i PTH, irregularly taking phosphate binder were the independently associated with targeting on serum phosphate.The high leve of serum phosphate and the low levels of hemoglobin were the independent risk factors of non-targeting on i PTH.Conclusions: The results of our center that patients with high prevalence of CKD-MBD was similar to other dialysis centers. The control rates of serum calcium, serum phosphate, i PTH and the prevalence of CKD-MBD showed no statistical difference in both the CAPD group and the MHD group.The overall control rates of calcium and phosphate in hemodialysis patients was similar with DOPPS4 target. Some measurements may be benefit for the control of CKD-MBD, such as increasing hemoglobin level, reducing serum phosphorus level, protecting the residual renal function and regulating phosphorus binder taken. However, iatrogenic mineral-bone disorder should be carefully avoided. |
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