Investigation of maintenance hemodialysis patients with mineral and bone disorder in Anhui province

Abstract

Objective To understand the mineral and bone disorder (MBD) status in the maintenance hemodialysis (MHD) patients in Anhui province; To explore the risk factors of hyperphosphatemia. Methods The cases of MHD patients were investigated in hemodialysis centers of 26 hospitals, including 19 tertiary hospitals, seven secondary hospitals, of southern, northern and central Anhui province from January 1st, 2014 to March 31st, 2014. Research content included general demographic characteristics, laboratory examination, clinical manifestation and medications, etc. Taking KDOQI and KDIGO guidelines as standard respectively, success rates of adjusted serum calcium, phosphorus, intact parathyroid hormone (iPTH) was observed and then compared with the dialysis outcomes and practice patterns study (DOPPS) 3 and DOPPS4. At last, success rate of adjusted serum calcium, phosphorus, intact parathyroid hormone (iPTH) in patients with MHD was compared in different hospitals of various grades. Results (1) Among the selected 2774 cases, 1662 cases of male, 1112 cases of female, with mean age (52.4±14.4) years old and the average dialysis time (45.4± 39.1) months, the top three original diseases were chronic glomerulonephritis (49.8%), hypertensive nephrosclerosis (18.7%) and diabetic nephropathy (15.4%). (2) On the basis of KDOQI guidelines: the success rate of adjusted serum calcium, serum phosphorus, iPTH in MHD patients was 40.1%, 36.9%, 23.0%, lower than DOPPS3 (50.4%, 49.8%, 31.4%) and DOPPS4 (56.7%, 52.6%, 29.6%) (P 0.05). (3) On the basis of KDIGO guidelines, the success rate of adjusted serum calcium, serum phosphorus, iPTH in MHD patients was 52.0%, 21.6% and 47.8% respectively. (4) Comparing different hospitals of various grades: the success rate of serum phosphorus and iPTH in tertiary hospital patients was significantly higher than secondary hospitals (P 0.05). (5) The treatment situation of MBD: on the basis of KDIGO guidelines, the inappropriate treatment of low serum calcium, hyperphosphatemia and secondary hyperparathyroidism (SHPT) accounted for 46.4%, 47.0% and 31.8% respectively. (6) Gender, age of dialysis, hemoglobin, region distribution and economic income level had nothing to do with hyperphosphatemia incidence; Overweight, and elevated serum albumin were independent risk factors of hyperphosphatemia; Tertiary hospitals and increasing age were protection factors of hyperphosphatemia. Conclusions The success rate of serum calcium, phosphorus and iPTH in MHD patients of Anhui province is not optimistic. MHD patients in tertiary hospitals with MBD are in more ideal control situation than the basic-level hospitals, thus it indicates that closer monitoring and management are expected to improve the success rate. Independent risk factors of hyperphosphatemia are overweight, elevated serum albumin; Tertiary hospitals and increasing age are protection factors of hyperphosphatemia. Key words: Hemodialysis; Kidney failure, chronic; Mineral and bone disorder