中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (04): 282-286.doi: 10.3969/j.issn.1671-4091.2020.04.019

• 中心管理与技术 • 上一篇    下一篇

武汉地区血液透析患者矿物质-骨异常现状分析

闵永龙1,2,程力1,2,李红波1,2,何家恒1,2,张燕敏1,2,熊飞1,2   

  1. 1武汉市第一医院肾病内科 2武汉市血液透析质量控制中心 (程力、闵永龙为共同第一作者)
  • 收稿日期:2020-01-06 修回日期:2020-02-22 出版日期:2020-04-12 发布日期:2020-04-12
  • 通讯作者: 熊飞 xiongf23@sina.com E-mail:xiongf23@sina.com
  • 基金资助:
    武汉市医学科研项目(WG18C01)；CKD-MBD青年研究基金项目(BCM01010)

Analysis of mineral and bone disorders in maintenance hemodialysis patients in Wuhan area

  1.  1Department of Nephrology of the First Hospital of Wuhan City, and 2Blood Dialysis Quality Control Center of Wuhan City,Wuhan 430022, China
  • Received:2020-01-06 Revised:2020-02-22 Online:2020-04-12 Published:2020-04-12

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摘要： 【摘要】目的通过分析武汉地区维持性血液透析(maintenance hemodialysis，MHD)患者的矿物质-骨异常(mineral and bone disorder,MBD)现状，进一步提高相关指标的达标率。方法以武汉市血液透析质量控制平台中的MHD 患者为研究对象，分析MBD 指标(钙、磷、甲状旁腺激素)的达标率及相关影响因素。结果①共有50 家透析单位4762 例MHD 患者纳入本研究，以K/DOQI(kidney disease outcomes quality initiative)为标准，钙(calcium,Ca)、磷(phosphorus,P)、甲状旁腺激素(parathyroid hormone,PTH)达标率分别为(46.5%、39.8%、24.6%)，均低于DOPPS3、DOPPS4 研究(χ2=110.274、259.780、87.424，P 均＜0.001)；②以武汉市质控标准，Ca、P、PTH 达标率分别为(64.4%、39.8%、51.7%)，年龄＜60 岁患者P 的达标率低于≥60 岁的患者(χ2=14.149，P＜0.001)；血管通路为动静脉内瘘(arteriovenous fistula，AVF)的患者Ca、P 的达标率高于非AVF 患者(χ2=6.555、27.800，P =0.010、＜0.001)；③血红蛋白(hemoglobin，Hb)达标的患者P、PTH 达标率相比较更高(χ2=21.211、31.106，P 均＜0.001)，白蛋白(albumin，ALB)达标的患者Ca 的达标率相对较高(χ2=10.474，P =0.001)，spKt/V 达标的患者Ca、P 的达标率相对较高(χ2=5.164、14.785，P =0.023、＜0.001)；④多因素Logstic 回归分析得出，Hb(OR=1.005,95% CI 1.001～1.008,P=0.008)、ALB(OR=1.087,95% CI 1.069～1.105,P＜0.001)、PTH(OR=1.001,95% CI 1.001～1.001,P＜0.001)是高磷的独立危险因素；AVF(OR=0.660,95% CI 0.577～0.756,P＜0.001)、sp-Kt/V(OR=0.792,95%CI 0.698～0.898,P＜0.001)是高磷的独立保护因素。结论武汉地区矿物质-骨异常控制尚可，但与DOPPS 还有一定差距，仍有进一步提高空间，血管通路方式、Hb、ALB、spKt/V 与高磷血症密切相关，需进一步加强质量控制。

关键词: 维持性血液透析, 矿物质-骨异常, 现状分析

Abstract: 【Abstract】Objective To analyze the mineral and bone disorder (MBD) in maintenance hemodialysis (MHD) patients in Wuhan area in order to improve the compliance rates of related indicators. Methods MHD patients registered in the Blood Dialysis Quality Control Center of Wuhan City were recruited as the study subjects. Their MBD indicators including serum phosphorus (P), calcium (Ca), intact parathyroid hormone (PTH) were collected, the compliance rates of these standards were compared with the results from Dialysis Outcomes and Practice Study (DOPPS), and factors associated with hyperphosphatemia were analyzed.
Result ①A total of 4,762 MHD patients from 50 dialysis centers were enrolled in this study. According to the standards in Kidney Disease Outcomes Quality Initiative (K/DOQI), the compliance rates of standard Ca, P and PTH were 46.5% , 39.8% and 24.6% respectively, lower than the rates in DOPPS3 and DOPPS4 (χ2=110.274, 466.402 and 70.512 respectively; P＜0.001). ② According to the quality control standards of Wuhan area, the compliance rates of standard Ca, P and PTH were 64.4%, 39.8% and 51.7% respectively. The compliance rate of standard serum P was lower in patients ＜60 years old than those ＞60 years old (χ2=14.149, P＜0.001), and the compliance rates of standard Ca and P were higher in patients with arteriovenous fistula (AVF) than those without AVF (χ2=6.555 and 27.800 respectively; P=0.010 and ＜0.001 respectively). ③ The compliance rates of standard P and PTH were higher in patients with the compliance of standard hemoglobin (Hb) (χ2=21.211 and 31.106; P＜0.001); the compliance rate of standard Ca was higher in patients with the compliance of standard albumin (ALB) (χ2=10.474, P=0.001); the compliance rates of standard Ca and P were higher in patients with the compliance of standard spKt/V (χ2=5.164 and 14.785 respectively; P=0.023 and ＜0.001 respectively). ④ Multivariate logistic regression analysis showed that Hb (OR= 1.005, 95% CI 1.00～1.008, P=0.008), ALB (OR=1.087, 95% CI 1.069～1.105, P＜0.001) and PTH (OR=1.001,95% CI 1.001～1.001, P＜0.001) were the independent risk factors for hyperphosphatemia, and AVF (OR=0.660, 95% CI 0.577～0.756,P＜0.001) and spK/tV OR=0.792, 95% CI 0.698～0.898, P＜0.001) were the independent protective factors for hyperphosphatemia. Conclusion The control of MBD in MHD patients was relatively satisfactory in Wuhan area, but was insufficient when compared with that in DOPPS. Blood access method, Hb, ALB and spKt/V were closely related to hyperphosphatemia. Dialysis quality control needs to be further strengthened.

Key words: Maintenance dialysis, Mineral and bone disorder, Situation analysis

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