腹膜透析与血液透析患者血清钙磷及甲状旁腺激素水平控制及其影响因素的对比研究

目的 对比血液透析及腹膜透析患者钙磷及甲状旁腺激素水平控制情况并分析相关影响因素.方法 单中心横断面观察研究纳入2013年3月至2015年3月在我院接受规律维持性透析治疗3个月以上、临床状况稳定的患者.收集患者临床资料,分析比较不同透析方式的患者血钙、血磷、全段甲状旁腺激素(intact parathyroid hor...     

维持性血液透析患者矿物质代谢研究

目的 探讨新乡地区维持性血液透析（MHD）患者矿物质代谢现况及相关影响因素,以提高本地区MHD患者生存质量.方法 收集2012年1月至2013年8月新乡地区4家综合性医院466例MHD3个月以上患者的临床资料.检测血清钙离子、磷、全段甲状旁腺激素（iPTH）及碱性磷酸酶（ALP）水平.分析MHD患者矿物质代谢现况及其与年龄、透析龄、营养不良、透析充分性的关系.结果 466例患者血钙平均值为（1.95±0.34） mmol/L,血磷平均值为（2.54± 1.38）mmol/L,iPTH平均值为（409±346）ng/L;钙、磷、iPTH达标率分别为34.3％（160/466）、20.4％（95/466）和25.5％ （119/466）.年龄≥60岁组（n=159）患者的血磷[（2.27±0.95）mmol/L比（2.68± 1.54） mmol/L]、iPTH[（344±235） ng/L比（437±383）ng/L]、ALP值[（49.0±36.4）mmol/L比（77.1±78.5） mmol/L]均低于年龄＜60岁组（n=307）（P均＜0.01）.iPTH＞ 300ng/L组（n=242）的血磷、ALP、透析龄明显高于iPTH≤300 ng/L组（n=224）（均P＜0.01）.透析龄≥24个月组（n=228）患者的血磷[（2.70±1.49） mmol/L比（2.35±1.20） mmol/L]、血钙[（1.88±0.35） mmol/L比（2.03±0.31） mmol/L]、iPTH[（493±384） ng/L比（301±249） ng/L]、ALP值[（74.3±73.3） mmol/L比（52.0±51.0）mmol/L]与透析龄＜24个月组（n=238）比较差异均有统计学意义（均P＜0.05）.结论 该地区MHD患者存在着明显的矿物质代谢紊乱及甲状旁腺机能亢进症,透析龄长的患者及年轻透析患者高磷血症、低钙血症更为突出.     

Correlation between quality of life and mineral metabolism in maintenance hemodialysis patients

Objective With multi-center investigation, to assess the life quality of patients with maintained hemodialysis (MHD) in Liaoning Province and to explore the relationship among the mineral metabolism, the life quality of the patients with MHD, and the repeated hospitalization within the latest three years. Methods 1192 patients with hemodialysis (at least 3 months) from January to March in 2015 at ten blood purification centers in Liaoning Province were selected for the cross - sectional survey. The Kidney Health-related Quality of Life (HRQOL) version 1.3 was used to evaluate the MHD patients' life quality. The total length of hospitalization was divided into four groups: 0 days, 3 to 15 days, 16 to 30 days and above 30 days. Results When serum calcium value ranged from 2.1 to 2.5 mmol/L, kidney - disease component summary (KDCS), mental component summary (MCS), physical component summary (PCS) and SF-36+KDCS corresponded to a higher value (P＜0.05). When serum phosphorus value ranged from 1.13 to 1.78 mmol/L, KDCS and SF-36+KDCS corresponded to a higher value (P＜0.05). When the calcium phosphorus product value ranged from 40.68 to 49.94, MCS corresponded to a higher value (P＜0.05). KDCS showed a linear correlation with age (P＜0.001), dialysis age, serum calcium (less than or equal to 2.5 mmol/L) (P＜0.05); PCS showed a linear correlation with age (P＜0.001) and dialysis age (P＜0.05); SF-36+KDCS showed a linear correlation with age (P＜0.001), and serum calcium (less than or equal to 2.5 mmol/L) (P＜0.05), while age and dialysis age were negatively correlated. The hospitalization days showed a linear correlation with age, dialysis age (P＜0.001) and serum phosphorus, calcium phosphorus product value (P＜0.05), while dialysis age and calcium phosphorus product value were negatively correlated. Among different groups of total hospitalization days in three years, age, hemodialysis age, serum calcium, serum phosphorus, calcium-phosphorus product value and quality of life values were all statistically significant (P＜0.05). Conclusions The life quality of patients with MHD were correlated with serum calcium, phosphorus, calcium and phosphorus product value, iPTH, dialysis age and age, while age and dialysis age were of negative correlation. The total number of hospitalization days in 3 years was closely linearly correlated with age and dialysis age, significantly correlated with serum phosphorus, calcium and phosphorus product value, while dialysis age, calcium and phosphorus product value were in a negative correlation. The total number of hospitalization in 3 years was correlated with the patients' age, dialysis age, serum calcium, serum phosphorus, calcium and phosphorus product value and quality of life.     

Relative contributions of inflammation and inadequate protein intake to hypoalbuminemia in patients on maintenance hemodialysis

Purpose

Serum albumin is one of the strongest mortality predictors in maintenance hemodialysis (MHD) patients. Yet, the degree to which serum albumin represents dietary protein intake or an inflammatory state, among others, is not clear. We hypothesize that these inadequate protein intake and inflammation contribute somewhat equally to hypoalbuminemia.

Methods

In a cross-sectional analysis, we examined correlates of low serum albumin, <3.8 g/dL, in 812 MHD patients in whom interleukin-6 (IL-6) and normalized protein nitrogen appearance (nPNA), also known as normalized protein catabolic rate (nPCR), were also measured. Logistic regression estimated odds ratios were employed, and spline models were plotted to examine the likelihood of relatively low serum albumin <3.8 g/dL.

Results

Mean age (±SD) of patients was 54 ± 15 years; 53 % of patients were men, 50 % Hispanic, 31 % African–American, and 55 % diabetic. The mean dialysis vintage was 31 ± 34 months (median: 19, inter-quartile range: 7–44 months). The baseline serum albumin, averaged over a 3-month period (mean ± SD), was 3.88 ± 0.38 g/mL. The unadjusted correlation coefficients of l IL-6 and nPNA with serum albumin were ?0.36 and +0.20, respectively (p < 0.001 for each comparison). The likelihood for an albumin <3.8 gr/dL increased linearly with decreasing nPNA and rising serum IL-6. This trend was steeper with increasing serum IL-6 up to a concentration of 30 ng/mL.

Conclusions

Both low protein intakes and a high state of inflammation are associated with low serum albumin in MHD patients.     

Relationship between endothelial progenitor cells and cardiovascular diseases in maintenance hemodialysis patients

Objective To investigate the relationship between the variation of endothelial progenitor cells (EPC) number and cardiovascular diseases (CVD) in maintenance hemodialysis (MHD) patients,and discuss the function of EPC in the progression of CVD in MHD. Methods One hundred and fifteen MHD patients over 18 years whose dialysis vintage was over six months from Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. They were divided into CVD group and non - CVD group by medical history, electrokardiographie (EKG), cardiac ultrasound, peripheral vascular imaging and cardiovascular imaging. Peripheral blood (5 ml) was collected for detecting EPC number by flow cytometry as CD34/CD133/vascular endothelial growth factor receptor 2 (VEGFR2) cells. The EPC number between CVD group and non-CVD group was compared. The relationship between the decrease of EPC number and CVD risks in MHD patients was analyzed by logistic regression analysis. In a three-year follow-up, the death and new CVD events of the two groups were compared in order to discuss the relationship between EPC number and adverse events. Results Among 115 MHD patients, the average age was 61.57 ± 12.76, male/female was 71/44, the average dialysis vintage was (86.24 ± 56.31) months, the average Kt/V was 1.69±0.29 and average ultrafiltration volume was (2.48±0.90) L. Forty-four patients in 115 (38.3%) were with concurrent CVD. The EPC number in CVD group was significantly lower than that in non CVD group (P=0.015). The CVD group had higher serum phosphate (P=0.013), higher glycosylated hemoglobin (P＜0.001), but serum calcium, intact parathyroid hormone (iPTH) and other indicators had no significant difference between two groups. Multiple Logistic regression analysis showed that older age (OR=1.061), history of diabetes (OR=9.796), dialysis vintage (OR=1.015), serum phosphate (OR=3.766), decrease of EPC number (OR=0.909) were the independent impact factors of CVD events in MHD patients. There were 22 patients of the 115 MHD patients had encountered a new CVD event in a three-year follow-up between December 2012 and December 2015, 9 patients from the CVD group and 13 patients from the Non-CVD group, and there was no significant difference between two groups (P=0.776). Nine patients from the CVD group and 7 patients from the Non-CVD group died in the follow-up, and there was no significant difference (P=0.111). Seventy-one MHD patients from the non-CVD group were divided into two groups by the median of EPC number. There were 3 patients in the higher EPC number group encountered CVD events and 10 patients in the lower EPC number group encountered CVD events, which had significant difference (P=0.024). Conclusion The decrease of circulating EPC number may be related with CVD events in MHD patients. Even adjusted by age, sex, diabetes, dialysis vintage and serum phosphate, decreased EPC number is still the independent risk factor of CVD events in MHD patients. The decrease of EPC number in MHD patients may be used to predict the occurrence of cardiovascular events.     

血液透析患者血清FGF23水平的影响因素及其与矿物质骨代谢异常的关系研究

目的分析维持性血液透析患者血清成纤维细胞生长因子23(FGF23)水平的影响因素,并探究其与矿物质骨代谢异常及血管钙化的关系。 方法2018年1月至2月期间纳入在南方医科大学附属东莞市人民医院进行维持性血液透析3个月以上患者380例,记录其性别、年龄、透析龄、透析充分性及降磷药物使用情况。透析前抽取血清检查钙、磷、全段甲状旁腺素(iPTH)及碱性磷酸酶等矿物质骨代谢指标,以及血红蛋白、白蛋白、血糖、血脂、血清超敏C反应蛋白(hs-CRP)、血清β2微球蛋白等指标。使用酶联免疫吸附法(ELISA)检测血清FGF23,多层螺旋CT进行冠状动脉钙化评分(MSCT)。采用t检验和卡方检验对维持性血液透析患者FGF23的影响因素进行单因素分析,之后使用多元线性逐步回归方法进行多因素分析。 结果本中心维持性血液透析患者血清FGF23中位数水平为8 905.3 ng/L,根据患者的FGF23水平50%中位数将患者分为低水平组(组1)和高水平组(组2)两组。单因素分析结果表明,透析龄、每次透析时间、透析超滤量及使用非含钙降磷药物和透析频次为FGF23水平的影响因素。透析龄更大,每次透析时间长,每周透析次数多、透析超滤量大的患者FGF23水平更高(均P<0.05)。在FGF23水平高于中位数的患者中,尿素氮、血肌酐和血清β2微球蛋白水平更高(均P<0.05)。多元线性回归分析显示,透析龄长和血肌酐升高是FGF23升高的危险因素(均P<0.001)。同时,高FGF23水平与血清钙、血清磷、iPTH水平和高冠状动脉钙化评分相关。 结论透析龄、每次透析时间、透析超滤量、透析频次、尿素氮、血肌酐、血清β2微球蛋白水平与维持血液透析患者FGF23升高有关。透析龄长和血肌酐高是FGF23升高的危险因素。FGF23与维持性血液透析患者矿物质骨代谢和冠状动脉钙化明显相关。     

Cinacalcet (KRN1493) effectively decreases the serum intact PTH level with favorable control of the serum phosphorus and calcium levels in Japanese dialysis patients.

BACKGROUND: Cinacalcet hydrochloride (KRN1493) acts on the parathyroid calcium receptors to suppress parathyroid hormone (PTH) secretion, and is already in wide use in the United States and the European countries. In this study, we examined the efficacy and safety of cinacalcet in Japanese patients on maintenance haemodialysis. METHODS: One hundred forty-four patients with serum intact PTH (iPTH) levels >or=300 pg/ml were enrolled and randomly allocated to two groups assigned to receive either cinacalcet or placebo for 14 weeks. Cinacalcet was started at the dose of 25 mg/day and titrated up to 100 mg/day to achieve the target iPTH level of <250 pg/ml. RESULTS: Cinacalcet significantly decreased the median iPTH level from 606.5 pg/ml to 241.0 pg/ml, despite the mean dialysis vintage being 2.4 times longer (14.3+/-7.1 years) and the proportion of patients receiving vitamin D sterols being higher, than in the phase 3 studies conducted in the US/EU. The target iPTH level was achieved in 51.4% of the patients in the cinacalcet group, in sharp contrast to only 2.8% in the placebo group. Furthermore, the percentage of patients with both the serum calcium and phosphorus levels within the target range in the K/DOQI guidelines increased from 4.2% to 26.4% by cinacalcet. CONCLUSIONS: These results suggest that lower dose levels of cinacalcet, as compared to those in US/EU studies, may be sufficient effectively suppress the serum iPTH levels and allow favourable management of the serum calcium and phosphorus levels in Japanese patients, having a longer average dialysis vintage.     

Association between vitamin C deficiency and dialysis modalities

Aim: We designed a cross‐sectional study to investigate plasma vitamin C level in patients who underwent maintenance haemodialysis (MHD) and continuous ambulatory peritoneal dialysis (CAPD) to explore whether there is a difference in vitamin C deficiency between MHD patients and CAPD patients. Methods: This investigation included 382 dialysis patients without vitamin C supplement before the study. Demographic characteristics, laboratory tests, ascorbic acid and total plasma vitamin C level were measured. A linear regression model was built to explore the association between vitamin C deficiency and dialysis modalities after adjusting for age, dialysis vintage, gender, Charlson index, modality of dialysis and hsCRP. Results: The range of plasma vitamin C level was from 0.48 µg/mL to 31.16 µg/mL. 35.9% (n = 137) patients had severe vitamin C deficiency (<2 µg/mL). Plasma vitamin C level was inversely associated with age and dialysis vintage. After age and dialysis vintage were adjusted, vitamin C deficiency was associated with MHD. R square for model fitting was relatively low, which implied that there were other vitamin C influencing factors not included in the model. Conclusions: Vitamin C deficiency is common in dialysis patients, especially in patients treated with MHD.     

Conjunctival and corneal calcificationin is associated with abdominal aortic calcification in maintenance haemodialysis patients

Objective To determine the condition of conjunctival and corneal calcificationin in maintenance haemodialysis patients, and explore the relationship between conjunctival and corneal calcificationin (CCC) and abdominal aortic calcification (AAC). Methods CCC was evaluated by slit-lamp eye photographs, and was graded and scored according to Porter’s classification system in the literature. Abdomen 1ateral X-ray examination were used as a criteria to determine the abdominal aortic calcification. The abdominal aortic calcification (AAC) score was calculated. Spearman correlation coefficient was used to analyze the relationship between CCC and AAC. Logistic regression analysis was used to determine the risk factor of CCC in MHD patients. Results Ninety-eight MHD patients were recruited. Their average age and dialysis vintage were (61.89±12.54) years and 51.67 (3.00～192.00) months, ninety-seven patients had conjunctival and corneal calcificationin, and seventy-two patients had abdominal aortic calcification, The median CCC was 8 (0, 17), the median AAC was 6 (0, 20), and the CCC was positively correlated with AAC (r=0.376, P＜0.001). Compared with the patients of CCC score≤5, the patients of CCC score＞10 had a higher level of phosphate, calcium-phosphate product, iPTH, hs-CRP, and longer dialysis vintage, as well as a higher score of AAC (all P＜0.05). Multivariate logistic regression analysis showed that the higher score of AAC and the longer dialysis vintage were independent risk factors for severe corneal calcificationin calcification. Conclusions Conjunctival and corneal calcificationin is common in MHD patients, and CCC is positively associated with AAC, the risk of CCC rises as a result of a severer AAC and a longer dialysis vintage.     

Relationship between dietary phosphorus intake and nutritional status and calcium and phosphorus metabolism in patients with chronic kidney disease

Objective To evaluate the dietary phosphorus intake of non-dialysis patients with chronic kidney disease (CKD) 3-5 stage, and to explore the relationship between dietary phosphorus intake, nutritional status, and calcium and phosphorus metabolism. Methods A cross-sectional study was conducted. Non-dialysis patients of CKD 3-5 stage in Huashan Hospital outpatient clinic were selected. Three-day dietary diaries, anthropometric indicators, subjective global assessment (SGA) scores, blood and 24-hour urine biochemical indicators were collected. According to the median dietary phosphorus intake (873 mg/d), the patients were divided into high phosphorus intake group (≥ 873 mg/d) and low phosphorus intake group (＜873 mg/d). The differences of characteristics, anthropometric indicators, SGA scores, blood and urine biochemical indicators between the two groups were compared. Multivariate linear regression analysis was used to analyze the correlation between dietary phosphorus intake and different kinds of food intake. Results A total of 118 patients were enrolled. The daily energy intake was (25.48±4.45) kcal/kg, protein intake was (0.88±0.22) g/kg and phosphorus intake was (862.85±233.02) mg/d. There were no significant differences in body mass index and SGA scores between high phosphorus intake group and low phosphorus intake group. The waist circumference, hip circumference, waist-hip ratio and leg circumference of male patients in high phosphorus intake group were higher than those in low phosphorus intake group (all P＜0.05). There were no significant differences in anthropometric indicators between the two groups of female patients. The serum levels of intact parathyroid hormone (iPTH), sodium, triglyceride, blood RBC count, alanine aminotransferase, 24-hour urine urea nitrogen, 24-hour urine creatinine and 24-hour urine phosphate in the high phosphorus intake group were higher than those in the low phosphorus intake group (all P＜0.05). Multivariate regression analysis showed that pork and chicken contributed the most to dietary phosphorus intake, followed by fish and dairy. Conclusions The daily dietary phosphorus intake of non-dialysis of CKD 3-5 stage patients is slightly higher than the recommended intake. The increase of dietary phosphorus intake may lead to the increase of serum iPTH and sodium levels. Proper control of dietary phosphorus intake will not impair the nutritional status of CKD patients.     

肌注维生素D2治疗维持性血液透析患者25羟维生素D缺乏的临床观察

目的分析维持性血液透析患者的血清25-羟维生素D[25(OH)D]水平,探讨肌注维生素D2注射液治疗25羟维生素D缺乏的作用。 方法检测我院2020年12月至2021年2月170例维持性血液透析患者空腹血清25(OH)D水平,根据血清25(OH)D水平将患者分为严重缺乏组、缺乏组、不足组和正常组。分析血清25(OH)D水平与患者性别、年龄、透析龄、血红蛋白、白蛋白、血钙、血磷、全段甲状旁腺激素(iPTH)的相关性。其中86例维生素D缺乏或不足的血透患者,随机分为对照组(n＝43)和治疗组(n＝43),对照组给予常规治疗,治疗组在对照组基础上给予肌注维生素D2 (20万单位,1次/2周),连续3个月。比较患者治疗前后血清25(OH)D、血红蛋白、白蛋白、钙、磷、iPTH水平的变化,并观察不良反应情况。 结果170例患者中,维生素D严重缺乏组33例(19.4%),缺乏组33例(19.4%),不足组70例(41.2%),正常组34例(20%)。男性25(OH)D水平显著高于女性(P<0.05)。正常组与维生素D缺乏组和不足组在透析龄、血红蛋白、白蛋白差异方面均具有统计学意义(P<0.05)。血清25(OH)D与年龄、血钙、血磷、甲状旁腺激素无显著相关性(P>0.05)。多元线性逐步回归分析显示,血清25(OH)D与血红蛋白、白蛋白具有相关性(P<0.05)。肌注维生素D2 3月后可使血液透析患者的25(OH)D水平显著上升(P<0.05),同时血红蛋白、血清白蛋白、磷上升(P<0.05),对血钙、iPTH无显著影响(P>0.1)。 结论维持性血液透析患者维生素D缺乏发生率高,血清25(OH)D水平与性别、贫血、营养不良存在密切关系,肌注维生素D2可改善血透患者贫血、营养不良情况,但可能带来血磷升高。     

低钙透析液对血液透析伴继发性甲状旁腺功能减退患者的临床研究

目的：探讨应用含钙1.25mmol／L浓度透析液进行血液透析对维持性血液透析（MHD）伴相继发性甲状旁腺功能减退患者的钙磷代谢和甲状旁腺功能的影响。方法：选择MHD6个月以上、病情稳定、连续2次血iPTH〈100pg／ml的患者60例,随机分为对照组（含钙1.5mmol／L透析液）和治疗组（含钙1.25mmol／L透析液）,每组各30例,观察时间6个月。观察并记录研究前、研究后l、3、6个月等不同时期患者血iPTH、血清校正钙、磷、钙磷乘积等指标的变化以及相关不良反应。另外,选择使用含钙浓度1.5mmol／L和1.25mmol／L透析液进行MHD的患者各20例,检测单次透析前、透析结束时以及下次透析前的血清校正钙、磷和iPTH浓度。结果：（1）治疗组单次透析后血清校正钙、磷和钙磷乘积均较透析前明显下降,iPTH浓度较透前明显升高,P〈0.01;而对照组上述血钙和iPTH浓度无明显变化;（2）透析后治疗组血清校正钙和钙磷乘积较对照组明显下降,血iPTH浓度较对照组明显升高,P〈0.01;两组血磷浓度差异无统计学意义。（3）治疗组1个月后血清校正钙、磷和钙磷乘积较治疗前开始下降,3个月后进一步下降,P〈0.05,6个月后各项指标趋于稳定;iPTH水平1个月后较治疗前明显升高,并随着治疗时间的延长,逐渐升高,P〈0.01。（4）对照组治疗后1、3、6个月上述指标与治疗前比较差异无统计学意义。（5）两组透析过程中出现的不良反应差异无统计学意义。结论：对于血iPTH〈100pg／ml MHD患者应用含钙1.25mmol／L透析液进行血液透析能较好地控制其血清校正钙、磷、钙磷乘积水平,有效地改善被过度抑制的甲状旁腺功能,并且安全性良好。     

Relationship between anemia and clinic outcomes in maintenance hemodialysis patients

Objective To analysis the relationship between anemia and clinic outcomes retrospectively in maintenance hemodialysis patients for Renji Hospital, Shanghai Jiao Tong University School of Medicine, China. Methods This study enrolled all maintenance hemodialysis（MHD）patients between 1 January, 2007 and 31 December, 2014 at the Renji Hospital. They were followed up until death, cessation of hemodialysis, transfer to other centers or to the end of the study (31 December, 2014). Laboratory parameters, including hemoglobin concentrations, transferrin saturation, ferritin, serum albumin, were measured every 3 months. According to the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines, the patients were divided into target-hemoglobin group (110≤Hb ≤120 g/L) and non target-hemoglobin group ( 120 g/L), and then the compliance rate of Hb, Ferritin, transferrin saturation, and the influence factors of compliance rate of Hb as well as its relationship with the prognosis were analyzed. Results Total 517 maintenance hemodialysis patients were involved in this study. The mean age was (63.76±14.78) years and 59.96% patients were male. Only 35.20%, 91.26% and 31.18% of them met the K/DOQI defined targets for hemoglobin, transferrin saturation and ferritin levels. The average levels of TSAT and Ferritin had no significant difference between the target-hemoglobin group and the non target-hemoglobin group. Compared with patients in non target-hemoglobin group, the target-hemoglobin group had significantly higher qualified rate of transferrin saturation (94.97% vs 89.41%, P=0.045) and Ferritin (37.22% vs 28.13%, P=0.036). Multivariate logistic regression analysis showed that the serum albumin, blood intact parathyroid hormone (iPTH) and dialysis vintage were independent risk factors that affected whether hemoglobin was up to the target. Kaplan-Meier analysis showed that the 8-year survival rate and cardiovascular survival rate in target-hemoglobin group were obviously higher than that in the non target-hemoglobin group (86.70% vs 75.30%, χ2Log rank=7.134, P=0.008; 93.80% vs 85.30%, χ2Log rank=6.134, P=0.013, respectively). Dialysis frequency, age and ferritin were independent risk factors of all-cause mortality for non target-hemoglobin group, and Dialysis frequency was independent risk factors of cardio-cerebral vascular disease mortality for non target-hemoglobin group. Conclusions The compliance rate of hemoglobin in MHD patients is still not steady controlled. Blood iPTH, serum albumin and dialysis vintage are independent risk factors that affect whether hemoglobin is up to the target in MHD patients. Sub-standard hemoglobin increases both all-cause mortality and cardio-cerebral vascular disease mortality in MHD patients.     

Nutritional requirements in maintenance hemodialysis

There is a high prevalence of nutritional disorders in maintenance hemodialysis patients. This fact has been recently confirmed because larger routine assessments of MHD patients body composition are now performed. Food records and dietary interviews show spontaneous low intakes of protein and energy in many patients. An increasing dialysis dose above a Kt/V (single pool) of 1.5 may not improve patients nutritional intakes. Inflammation may further impair the balance between protein synthesis and catabolism and cause anorexia. In response to these abnormalities, the management of energy, protein, vitamins, and trace elements intake will be discussed with special emphasis on calcium, phosphorus, enteral support, and parenteral nutrition.     

Fibroblast Growth Factor 23 is a Predictor of Aortic Artery Calcification in Maintenance Hemodialysis Patients

Background: Our study aimed to investigate the factors associated with elevated plasma FGF23 (cFGF23) levels in maintenance hemodialysis (MHD) patients and to determine whether plasma FGF23 level is related to aortic artery calcification (AAC). Methods: This study included 120 MHD patients and 20 controls. The FGF23 level was measured using a C-terminal assay and AAC was detected by a lateral lumbar X-ray plain. Results: Plasma FGF23 levels were significantly higher among dialysis patients compared to controls: FGF23 level of 27691.42 ± 55646.41 RU/mL in MHD patients versus 49.89 ± 23.94 RU/mL in health people. Significant correlations were observed between FGF23 levels and vintage, intact parathyroid hormone (iPTH), serum phosphate, total calcium, 25(OH)D, urea nitrogen (BUN), and serum creatinine (SCR). Stepwise multiple regression analysis showed that the independent parameters associated with FGF23 level were serum phosphate, total calcium, parathyroid hormone (PTH), SCR, and prealbumin. There were 73 patients (60.83%) with visible calcification in the abdominal aorta. Bivariate analysis showed that AAC score correlated with FGF23, phosphate, total calcium, vintage, age, and diastolic blood pressure. Forward logistic analysis showed that the independent parameters associated with AAC were age, total protein, and Lg FGF23. Conclusion: Plasma FGF23 level is significant increased in hemodialysis patients and is independently associated with AAC.     

Intake of macronutrients and their relationship with total cholesterol and high-density lipoprotein cholesterol. The Coronary Risk Factor Study, 1979

In a dietary study on a subsample (1,113 males and females, 15-64 years of age) of the Coronary Risk Factor Study (CORIS) population, dietitians used the 24-hour recall method by interview to quantify nutrient intake and energy distribution and to investigate the relationship between dietary variables and blood lipid values. Mean total fat intakes varied from 35% to 37% of daily energy intake for different age groups. Dietary polyunsaturated/saturated fatty acid ratios varied from 0.48 to 0.59. Cholesterol intakes ranged from 243 mg/d to 500 mg/d and when expressed per 4.2 MJ (1,000 kcal) were similar for males and females. The results of this intrapopulation cross-sectional study showed no significant relationship between dietary variables and total serum cholesterol and high-density lipoprotein cholesterol. However, the low percentage of respondents who met the prudent dietary guidelines add dietary risk factors to the already high prevalence of other major risk factors in this population.     

Correlation between pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism

Objective To analyze the correlation between the pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism (SHPT), so as to improve the efficacy and safety of treatment. Methods The pathological and clinical data of 130 patients with renal SHPT and maintenance hemodialysis (MHD) who had undergone total parathyroidectomy with autotransplantation (TPTX+AT) were collected. A total of 545 parathyroid glands were obtained and 998 slices were made and read. According to the pathological types of parathyroid hyperplasia, the patients were divided into diffuse hyperplasia (DH) group, diffuse between hyperplasia and nodular hyperplasia (DH/NH) group as well as nodular hyperplasia (NH) group. The clinical and biochemical characteristics of different groups before and after operation (1-, 3-, 6-, 9-, 12-month) were compared and analyzed by statistical tests. Results (1) The preoperative status: the dialysis age, serum calcium as well as incidence of bone pain, skin itching and shorten height in the NH group were significantly higher than those in the DH group (all P＜0.05), and the serum phosphorus and iPTH in the NH group were significantly higher than those in DH and DH/NH group (all P＜0.05). (2) The postoperative status: the serum calcium of the NH group at 1-month was lower than that of the DH group, and the incidence of hypocalcemia of the NH group at 1-month was higher than that of the DH group (P＜0.05); the serum phosphorus at 3-, 6-, 9-month and iPTH at 1-, 3-month of the NH group were significantly lower than that of the DH group (all P＜0.05), and the serum phosphorus at 3-month and iPTH at 1-month of the NH group were lower than that of the DH/NH group (all P＜0.05). Among the 3 groups the serum phosphorus change from 1 to 12 months had difference (F=3.241, P=0.042), while the differences of serum calcium and iPTH changes were statistically insignificant. Conclusions The clinical manifestations, serum calcium, phosphorus and iPTH in patients with renal SHPT before and after TPTX+AT are closely related to the pathological types of parathyroid hyperplasia. Compared with the DH patients, before the operation the NH patients have longer dialysis age, more serious the clinical symptoms such as bone disease, higher calcium, phosphorus and iPTH, while greater reduction of the serum calcium, phosphorus and iPTH in the short term after operation.     

维持性血液透析患者生活质量与蛋白质能量消耗和微炎症状态的相关性研究

目的 探讨维持性血液透析(MHD)患者生活质量(QOL)与蛋白质能量消耗(PEW)和微炎症状态(MIS)的关系.方法 采用病例对照研究,观察2016年5月至2018年6月在桂平市人民医院行血液透析治疗的慢性肾脏病5期患者,按照是否合并PEW分为PEW组和非PEW组,按照是否存在MIS分为MIS组与非MIS组;分析患者的...