关键词: 血液透, 血磷, 校正血清钙, 甲状旁腺激素, 达标

Abstract: Objective To investigate the serial changes and the status on achieving serum phosphorus(P), calcium(Ca),intact parathyroid hormone(iPTH) targets in hemodialysis(HD) patients, and explore their correlations with mortality. Methods The authors performed a single-center retrospective study of HD patients from
Beijing Aerospace General Hospital,between January 2012 and December 2012,evaluating the status on achieving the targets for Ca and P and iPTH set by the K/DOQI guideline,and serial changes in Ca, P and iPTH values at each scheduled visit. Ninety- two patients were eligible for this study. Results During the
study period, in the ninety-two patients, seventy-nine patients survived, and thirteen patients died, of whom seven died of cardiovascular disease, six died of cerebrovascular events. The percentages of patients within the Ca target were low and varied significantly (from 29.3% to 17.7%,P＜0.05). There was no notable improved trend in the percentages of patients within P target from 34.8% to 29.1% over one year (P＞0.05). The percentages of patients within the iPTH target increased from initial 29.3% to 43% at visit 4, the difference was not statistically significant (P＞0.05). The rate of patients who achieved both serum Ca and P levels consistent within the targets was 7.6% at reference visit and 13.0% at visit 5. The rates of patients who simultaneously achieved the Ca, P, iPTH targets was 1.3% to 4.3%.There were no remarkable changes in the rates of patients receiving vitamin D or phosphate binders (P＞0.05) during the study. The levels of iPTH at visit 4, 5 were higher in hyperphosphataemia group than those in the serum P ＜1.78mmol/L group (P＜0.05). Compared with dialysis duration ＜18months group, serum iPTH levels at all the evaluation times were significantly higher in dialysis duration ≥18months group (P＜0.05).On the contrary, iPTH levels at each scheduled visit were not significantly different between the Ca＜2.10mmol/L group and the Ca≥ 2.10mmol/L group (P＞0.05).Multivariate logistic regression analysis demonstrated that longer dialysis duration (OR=1.052, 95%CI 1.017-1.069) and complicated by cardio cerebrovascular events (OR = 252. 17,95% CI 11.54-550.8) were positively associated with mortality, higher serum albumin was negatively associated with mortality (OR=0.700, 95% CI 0.506 to 0.969). Cox regression analysis showed that low and high calcium, high and low P, high iPHT and low iPTH were not associated with mortality after adjusting the covariates (all P＞0.05). Conclusion The achievement rates of serum Ca and P and iPTH targets set by K/DOQI were low in our hospital. Hyperphosphataemia and longer dialysis duration inhibited the achievement rate of serum iPTH guideline target. The status on sustained achieving serum Ca, P, iPTH targets had no significant influence on the mortality of HD patients in this study. Further exploration is required.

Key words: hemodialysis, serum phosphate, correct serum calcium, intact parathyroid hormone, achieving the target