Analysis of influencing factors for calcium and phosphorus metabolism abnormalities in patients with peritoneal dialysis at a single center
-
摘要: 目的 回顾性分析山西医科大学第二医院腹膜透析中心近5年腹膜透析（peritoneal dialysis，PD）患者钙磷及全段甲状旁腺素（intact parathyroid hormone，iPTH）等相关生化指标，分析矿物质及骨代谢异常产生的原因，进一步提高PD患者的生活质量和改善预后。方法 选取山西医科大学第二医院2014年1月至2018年12月间进行长期维持性腹膜透析患者102例，随访3个月以上，回顾性分析患者的基线和最后一次回院随访资料。了解其钙磷代谢紊乱情况，并按血钙、血磷及iPTH水平分为达标组、不达标组，比较两组临床资料差异，探讨山西省部分地区PD患者钙磷代谢不达标的影响因素。结果 PD患者中，男女比0.79∶1，年龄（51.2±13.9）岁，基线血钙、血磷、iPTH及碱性磷酸酶（alkaline phosphatase，ALP）水平分别为（2.07±0.26）mmol/L、（1.8±0.5）mmol/L、（387.8±40.3）pg/mL、（103.9±10.3）U/L，最后一次随访时平均血钙、血磷、iPTH及ALP水平分别为（2.16±0.27）mmol/L、（2.0±0.8）mmol/L、（497.8±39.6）pg/mL、（101.4±10.0）U/L。血钙、血磷及iPTH达标率分别为37.25%、48.04%、19.61%，最后一次随访时血钙、血磷及iPTH达标率分别为48.04%、34.31%、13.73%。钙磷代谢指标控制不达标因素分析结果显示：基线血肌酐（Scr）是血钙不达标的影响因素；基线钙磷乘积是血磷不达标的影响因素；透析时间是iPTH不达标的影响因素；透析时间、基线ALP是ALP不达标的影响因素。结论 山西地区PD患者钙磷代谢紊乱问题突出，血钙、磷及iPTH达标率不理想，影响钙磷代谢不达标的因素有Scr、透析时间、钙磷乘积。Abstract: Objective To retrospectively analyze the biochemical indexes such as calcium,phosphorus and intact parathyroid hormone(iPTH)in Peritoneal Dialysis(PD)Center of the Second Hospital of Shanxi Medical University in recent 5 years,analyze the causes of abnormal mineral and bone metabolism,and further improve the quality of life and prognosis of patients with peritoneal dialysis. Methods A total of 102 patients,who underwent long-term peritoneal maintenancedialysis in Peritoneal Dialysis(PD)Center of the Second Hospital of Shanxi Medical University from January 2014 to December 2018,were selected and followed up for over 3 months,in order to retrospectively analyze the baseline and the last hospital visit data of the patients.After calcium and phosphorus metabolism disorder was understood,all the patients were divided into normal and abnormal groups according to serum calcium,phosphorus and iPTH levels.The difference of clinical data was compared between the normal group and the abnormal group,and the influencing factors for calcium and phosphorus metabolism abnormalities in PD patients in some areas of Shanxi Province were discussed. Results In peritoneal dialysis patients,the ratio of males to females was 0.79:1,the mean age was(51.2±13.9)years old,the mean serum calcium,phosphorus,iPTH and ALP levels were(2.07±0.26)mmol/L,(1.8±0.5)mmol/L,(387.8±40.3)pg/mL,(103.9±10.3)U/L,respectively.At the last follow-up the levels of serum calcium,phosphorus,iPTH and ALP were(2.16±0.27)mmol/L,(2.0±0.8)mmol/L,(497.8±39.6)pg/mL,and(101.4±10.04)U/L,respectively.The normality rates of serum calcium,phosphorus and iPTH were 37.25%,48.04% and 19.61%,respectively.At the last follow-up,the normality rates of serum calcium,phosphorus and iPTH were 48.04%,34.31% and 13.73%,respectively.Analysis offailure in control of calcium and phosphorus metabolism indicators:serum creatine(Scr)at baseline is aninfluencing factor for abnormal Blood calcium.The product of baseline calcium and phosphorus is an influencing factor for abnormal serum phosphorus.Dialysis age was an influencing factor for abnormal iPTH.Dialysis age and baseline ALP were influencing factors for abnormal ALP. Conclusions The disorder of calcium and phosphorus metabolism in PD patients in Shanxi Province is emerging,and the normality rates of serum calcium,phosphorus and iPTH are not ideal.The influencing factors of calcium and phosphorus metabolism abnormalities are serum creatinine,dialysis age and calcium and phosphorus product.
-
-
[1] Heaf JG.Chronic kidney disease-mineral bone disorder in the elderly peritoneal dialysis patient[J].Perit Dial Int,2015,35(6):640-644.DOI: 10.3747/pdi.2014.00339.
[2] Saran R,Li Y,Robinson B,et al.US renal data system 2015 annual data report:epidemiology of kidney disease in the United States[J].Am J Kidney Dis,2016,67(3 Suppl 1):S1-Svii,S305.DOI: 10.1053/j.ajkd.2015.12.014.
[3] Oliveira MC,Bufarah MNB,Ponce D,et al.Longitudinal changes in nutritional parameters and resting energy expenditure in end-stage renal disease[J].J Bras Nefrol,2020,42(1):24-30.DOI: 10.1590/2175-8239-JBN-2018-0169.
[4] Vervloet MG,Sezer S,Massy ZA,et al.The role of phosphate in kidney disease[J].Nat Rev Nephrol,2017,13:27-38.DOI: 10.1038/nrneph.2016.164
[5] 陆晓蓉.腹透患者钙磷代谢达标率及与患者预后的相关研究[J].上海交通大学学报,2016:1-68. DOI: 10.27307/d.cnki.gsjtu.2016.004246. [6] 蒙东梅,潘玲,黎伟.腹膜透析患者钙磷代谢紊乱调查及不达标影响因素分析[J].山东医药,2019,59(4):61-64.DOI: 10.3969/j.issn.1002-266X.2019.04.016. [7] 冯韵霖,陈瑾,杨帆,等.腹膜透析患者血清钙、磷与全段甲状旁腺激素的相关因素[J].当代医学,2017,23(26):3-6.DOI: 10.3969/j.issn.1009-4393.2017.26.002. [8] 周艳,方炜,严豪,等.腹膜透析患者腹主动脉钙化评估及相关因素分析[J].中华肾脏病杂志,2015,31(6):419-424.DOI: 10.3760/cma.j.issn.1001-7097.2015.06.004. [9] 李子贵.血液透析与腹膜透析对尿毒症患者在钙、磷代谢的影响.中外医疗,2015,31(22):106-107.DOI: 10.16662/j.cnki.1674-0742.2015.22.012. [10] Liu CT,Lin YC,Lin YC,et al.Roles of serum calcium,phosphorus,PTH and ALP on mortality in peritoneal dialysis patients:a nationwide,population-based longitudinal study using TWRDS 2005-2012[J].Sci Rep,2017,7(1):33.DOI: 10.1038/s41598-017-00080-4.
[11] Imtiaz R,Hawken S,McCormick BB,et al.Diabetes mellitus and younger age are risk factors for hyperphosphatemia in peritoneal dialysis patients[J].Nutrients,2017,9(2):E152.DOI: 10.3390/nu9020152.
[12] Sprague SM,Evenepoel P,Curzi MP,et al.Simultaneous control of PTH and CaxP Is sustained over three years of treatment with cinacalcet HCl[J].Clin J Am Soc Nephrol,2009,4(9):1465-1476.DOI: 10.2215/CJN.06141108.
[13] Jean G,Lataillade D,Genet L,et al.Association between very low PTH levels and poor survival rates in hemodialysis patients:results from the French ARNOS cohort[J].Nephron Clin Pract,2011,118(2):c211-c216.DOI: 10.1159/000321642.
-
期刊类型引用(2)
1. 李志龙，陈斯韵，魏晓萍. 维持性血液透析患者钙磷代谢异常危险因素与干预措施分析. 临床合理用药杂志. 2021(18): 27-29 . 
百度学术
2. 刘丽，邱涵. 碳酸司维拉姆对透析患者慢性肾脏病-矿物性骨紊乱参数的影响. 中国处方药. 2021(12): 86-87 . 百度学术
其他类型引用(1)
计量
- 文章访问数: 388
- HTML全文浏览量: 0
- PDF下载量: 355
- 被引次数: 3
下载:
.png)