Abstract: Objective To investigate the effect of continuous quality improvement (CQI) on bone mineral metabolism in maintenance hemodialysis (MHD) patients. Methods We observed 97 MHD patients with abnormal bone mineral metabolism in our hospital during July 2014 to 2015 June. According to the "Guidance for Diagnosis and Treatment of Mineral and Bone Disorder in Chronic Kidney Disease”issued by Nephrology Association of Chinese Medical Association in September 2013, they were managed with CQI to intensify supervision and intervention of the treatment, to establish continuous quality improvement team, and to attract patients and their families taking part into the administration of treatment through the four steps called PDCA (plan, do, check and act). The observation period lasted 12 months. Changes of serum Ca, P and PTH levels and the compliance rate of serum Ca, P and iPTH were evaluated before and after CQI. Results After CQI, the abnormal calcium and phosphorus metabolism in MHD patients improved in our hospital. Serum phosphorus decreased from 2.42±0.76 mmol/L to 2.13±0.80 mmol/L (t=2.589, P=0.011) with the increase of compliance rate from 24.74% to 41.24% (χ2=5.969, P=0.014); average serum iPTH decreased from 445.97± 407.22ng/ml to 335.21 ± 386.23 ng/ml (t=1.942, P=0.043), with the increase of compliance rate from 34.02% to 48.45% (χ2=3.312，P=0.041); average serum Ca increased from 2.23±0.40 mmol/L to 2.24±0.25 mmol/L (t=0.212, P=0.901) with the increase of compliance rate from 45.36% to 56.70% (χ2=2.490, P= 0.114). In addition, the number of patients accepting new therapeutic measures increased; the number of patients using non-Ca-P binders increased from 1.03% to 12.37% (χ2=9.976, P=0.001); the number of patients used combined blood purification methods from 36.08% to 57.73% (χ2=9.168, P=0.002); the number of patients having parathyroid surgery increased from 2.06% to 11.34% (χ2=6.678, P=0.001); the number of patients using active vitaminD decreased from 64.95% to 55.67% (χ2=1.744, P=0.187). Conclusion Continuous quality improvement can effectively improve the abnormal Ca-P metabolism in MHD patients.

Key words: Continuous Quality Improvement, Chronic Kidney Disease-mineral and Bone Disorder, Abnormal calcium and phosphorus metabolism , Hyperphosphatemia, Hemodialysis