Analysis of serum phosphorus achieved standard state in maintenance hemodialysis patients

Objective To know the situation of serum calcium and phosphorus achieved standard state in maintenance hemodialysis (MHD) patients through analyzing the clinical data of MHD patients in Kunming Blood Purification Center of the First Peoples' Hospital of Kunming City. To investigate nutritional status and short term prognosis in different serum phosphorus level groups of those MHD patients, so as to select appropriate method of serum phosphorus intervention.Methods 173 MHD patients were enrolled in this study. The indexes named serum phosphorus, serum calcium, intact parathyroid hormone (iPTH), serum albumin (Alb), cholesterol (TC), and body mass index (BMI) were tested every three months for and continued six times. The average value for each index was calculated. Four groups were set up according to the average values of serum phosphorus:low phosphorus, standard phosphorus, high phosphorus, and ultra-high phosphorus groups, respectively. T-test, chi-square test and rank sum test were used to analyze the case fatality rate, nutritional status and other indexes. Logistic regression was used to analyze the related factors.Results Various indexes achieved standard rate in total 173 patients was 42.2% in serum phosphorus, 67.6% in serum calcium, 52.6% in iPTH, 67.6% in calcium-phosphorus product, 43.4% in ALB, 64.7% in TC and 60.7% in BMI, respectively. The serum phosphorus, calcium and iPTH together achieved standard rate was only 15.6% (27/173). The case fatality rate of the four groups was the highest in the low phosphorus group (32.6%) and the lowest in the standard phosphorus group (10.9%), but no statistically significant difference existed between them (P>0.05). The ALB level was the highest in the high phosphorus group (55.6%), and the lowest in the low phosphorus group (15.8%). As compared with standard phosphorus group, only the low phosphorus group has statistically difference was found (P<0.05) for Alb in four groups. Univariate analysis showed that age, Ca, P, iPTH and TC were significantly related with the case fatality rate. Logistic regression analysis showed that only the age and TC had statistically significant correlation with case fatality rate.Conclusions In MHD patients, the incidence of serum calcium and phosphorus metabolism disorders and malnutrition is high. In view of the nutrition and serum calcium and phosphorus metabolism status, serum phosphorus control in standard state was not the best. It implies that the control method of serum phosphorus should be emphasized on the phosphorus reduction by drug and adequate dialysis. In the period of low phosphorus diet, the nutritional status should be taken into account. Both serum calcium and phosphorus metabolism and nutritional status achieved standard state is more beneficial to patients.