Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
BMC Nephrol. 2012 Sep 21;13:116. doi: 10.1186/1471-2369-13-116.
BACKGROUND: Mineral and bone disorder (MBD) in patients with chronic kidney disease is associated with increased morbidity and mortality. Studies regarding the status of MBD treatment in developing countries, especially in Chinese dialysis patients are extremely limited. METHODS: A cross-sectional study of 1711 haemodialysis (HD) patients and 363 peritoneal dialysis (PD) patients were enrolled. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH) were analyzed. The achievement of MBD targets was compared with the results from the Dialysis Outcomes and Practice Study (DOPPS) 3 and DOPPS 4. Factors associated with hyperphosphatemia were examined. RESULTS: Total 2074 dialysis patients from 28 hospitals were involved in this study. Only 38.5%, 39.6% and 26.6% of them met the Kidney Disease Outcomes Quality Initiative (K/DOQI) defined targets for serum P, Ca and iPTH levels. Serum P and Ca levels were statistically higher (P < 0.05) in the HD patients compared with those of PD patients, which was (6.3 ± 2.1) mg/dL vs (5.7 ± 2.0) mg/dL and (9.3 ± 1.1) mg/dL vs (9.2 ± 1.1) mg/dL, respectively. Serum iPTH level were statistically higher in the PD patients compared with those of HD patients (P = 0.03). The percentage of patients reached the K/DOQI targets for P (37.6% vs 49.8% vs 54.5%, P < 0.01), Ca (38.6% vs 50.4% vs 56.0%, P < 0.01) and iPTH (26.5% vs 31.4% vs 32.1%, P < 0.01) were lower among HD patients, compared with the data from DOPPS 3 and DOPPS 4. The percentage of patients with serum phosphorus level above 5.5 mg/dL was 57.4% in HD patients and 47.4% in PD patients. Age, dialysis patterns and region of residency were independently associated with hyperphosphatemia. CONCLUSIONS: Status of MBD is sub-optimal among Chinese patients receiving dialysis. The issue of hyperphosphatemia is prominent and needs further attention.
背景：慢性肾脏病患者的矿物质和骨代谢紊乱（MBD）与发病率和死亡率的增加有关。关于发展中国家（尤其是中国透析患者）MBD 治疗状况的研究极为有限。
方法：对 1711 名血液透析（HD）患者和 363 名腹膜透析（PD）患者进行横断面研究。分析 MBD 相关参数，包括血清磷（P）、钙（Ca）、全段甲状旁腺激素（iPTH）。将 MBD 目标的达标情况与 Dialysis Outcomes and Practice Study（DOPPS）3 和 DOPPS 4 的结果进行比较。检查高磷血症的相关因素。
结果：本研究共纳入来自 28 家医院的 2074 名透析患者。仅有 38.5%、39.6%和 26.6%的患者符合肾脏病预后质量倡议（K/DOQI）定义的血清 P、Ca 和 iPTH 水平目标。与 PD 患者相比，HD 患者的血清 P 和 Ca 水平更高（P<0.05），分别为（6.3±2.1）mg/dL 和（9.3±1.1）mg/dL 与（5.7±2.0）mg/dL 和（9.2±1.1）mg/dL。PD 患者的血清 iPTH 水平高于 HD 患者（P=0.03）。与 DOPPS 3 和 DOPPS 4 相比，达到 K/DOQI 血清 P 目标的患者百分比（37.6%比 49.8%比 54.5%，P<0.01）、Ca（38.6%比 50.4%比 56.0%，P<0.01）和 iPTH（26.5%比 31.4%比 32.1%，P<0.01）较低。与 DOPPS 3 和 DOPPS 4 相比，HD 患者血清磷水平>5.5mg/dL 的患者百分比为 57.4%，PD 患者为 47.4%。年龄、透析模式和居住地区域与高磷血症独立相关。
结论：中国透析患者 MBD 状况不理想。高磷血症问题突出，需要进一步关注。
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