【Abstract】Objective To investigate the bone and mineral metabolism status in maintenance hemodialysis (MHD) patients treated in primary hospitals in He’nan Province. Methods A total of 932 patients in 13 hemodialysis centers in He’nan province were enrolled in this study to understand their calcium, phosphorus, and intact parathyroid hormone (iPTH) levels in the recent 3 months. KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines were used as the standards to evaluate their calcium, phosphorus, iPTH levels and compliance rates then to compare them with the Dialysis Outcomes and Practice Patients Study 4
(DOPPS4 study). The patients were grouped according to gender, age, dialysis age, vascular access, primary disease, and total dialysis duration per week. The compliance rates were compared among the groups. Results Serum calcium was 2.23±0.25 mmol/L, phosphorus was 1.96±0.65 mmol/L and iPTH was 362(165, 647) pg/ml in the participants in these hemodialysis centers,with detection rates of 38.4%,50% and 49.4% respectively, compliance rates of 33.5%,29.6%, 21.8% respectively, and overall compliance rate of 3.9%. Hypocalcemia, hyperphosphatemia and higher iPTH level were more prominent than those in DOPPS4(29.0% vs. 12.4% , χ2=224.648, P＜0.001; 61.4% vs. 34.2% , χ2=303.262, P＜0.001; 59.2% vs. 35.4%, χ2=308.165, P＜0.001). In elderly patients, serum phosphorus and iPTH were lower [1.8±0.5 vs. 2.0±0.7 mmol/L, t=2.845, P=0.005; 291.9(173.8,500.0) vs. 439.9(200.0, 701.0) pg/ml, Z=3.404, P=0.001)] with the higher phosphorus and iPTH compliance rates(42.0% vs. 24.8%,χ2=5.110, P=0.024; 70.0% vs. 48.1%,χ2=6.986,P=0.008), but the compliance rate of calcium was lower (44.0% vs. 65.9%, χ2=7.182, P=0.007). Patients with poor blood access function had lower iPTH compliance rate (59% vs. 34.3%,χ2=6.943, P=0.008). Diabetic patients had lower iPTH level [318.6(79.0, 593.0) vs. 417.9 (216.0,694.7) pg/ml, Z=2.246, P=0.025] and higher serum phosphorus compliance rate (39.7% vs. 21.8%,χ2=6.812, P=0.009). Patients with long dialysis age had higher iPTH level [510.2(181.3, 869.6)vs. 355.0 (188.6, 543.0)pg/ml, Z=3.130, P=0.003] and lower iPTH compliance rate(35.7% vs. 62.6%,χ2=11.206, P=0.001). Patients with a weekly dialysis duration of＜10h had higher serum phosphorus (2.1±0.7 vs.1.9±0.6mmol/L,t=2.004,P=0.047) and lower blood calcium compliance rate (49.3% vs. 63.2%,χ2=7.875, P=0.005). Conclusion Disorders of calcium and phosphorus metabolism were common in MHD patients treated in the primary hospitals, which need to be changed in no time.
