Assessment of frailty and its influence factors in maintenance hemodialysis patients

Objective To investigate the frailty in maintenance hemodialysis (MHD) patients and its influence factors. Methods A total of 127 adults undergoing hemodialysis from January 2015 and January 2016 in our center were recruited. Their clinical data and blood biochemical data were collected. Frailty was assessed using Fried's Frailty Phenotype. Quantification of coronary artery calcification (CACs) was determined by multi-slice spiral computed tomography (MSCT). According to the frailty scores, patients were divided into non-frailty, pro-frailty and frailty group. Their in clinical and biochemical index as well as CACs were compared. The correlations of frailty scores with above index were assessed by Spearman's correlation. Multiple logistic regression analysis was applied to evaluate the effect factors of frailty on MHD patients. Results Among 127 selected patients, 46(36.22%) patients without frailty, 45(35.43%) patients with pro-frailty, and 36(28.35%) patients with frailty. The age, diabetes, haemoglobin, albumin, pre-albumin, C-reactive protein, fibroblast growth factor 23 (FGF23), CACs and left ventricular end-diastolic dimension (LVEDD) of the 3 groups had statistical differences (all P＜0.05). The degrees of calcification among 3 groups were also different statistically (F=31.769, P＜0.001). In patients with MHD, frailty was positively correlated with age (r=0.545, P＜0.001), diabetes (r=0.236, P=0.008), C-reactive protein (r=0.245, P=0.006), FGF23 (r=0.189, P=0.034) and CACs (r=0.396, P＜0.001), while negatively correlated with haemoglobin (r=-0.257, P=0.004), albumin (r=-0.380, P＜0.001), pre-albumin (r=-0.313, P＜0.001). Age (OR=1.076), C-reactive protein (OR=1.176), albumin (OR=0.796) and artery calcification (OR=2.465) were independent influence factors for frailty in MHD patients (all P＜0.05). Conclusions The prevalence of frailty is high among MHD patients. Frailty is associated with age, C-reactive protein, albumin and artery calcification in MHD patients.     

Analysis of post-dialysis fatigue in maintenance hemodialysis patients

Objective To analysis the post-dialysis fatigue status of maintenance hemodialysis patients, explore the influencing factors in these patients and propose effective interventions. Methods One hundred and twenty maintenance hemodialysis patients in Department of Nephrology, Second Affiliated Hospital of Nanjing Medical University were enrolled. Clinical data were obtained by questionnaires. Biochemical changes before and post hemodialysis were recorded. The serum concentrations of hemoglobin, albumin, electrolyte, bicarbonate and lactic acid were collected for analysis. Results One hundred and nine (90.8%) effective questionnaires were collected, in which more than half of patients claimed to experience post-dialysis fatigue. Time to recover from hemodialysis (TIRD) was different: the median (interquartile range) time was 2.00(0.00, 3.00) hours. In the study, 30.3% patients reported no fatigue after hemodialysis. Recovery time in 35.8% patients was more than 30 minutes to 2 hours, 22.0% was 3 to 4 hours, 11.0% was 5 to 12 hours, 0.9% patients took longer time to recover from a dialysis session. According to the recovery time, these patients were divided into three groups. Among the three groups, the ultrafiltration, the serum sodium and lactic acid after dialysis showed significant difference. It was showed by the unconditional logistic regression analysis that ultrafiltration (OR=2.35, 95%CI 1.44-3.83), serum sodium (OR=0.75, 95%CI 0.65-0.88) , lactic acid (OR=3.16, 95%CI 1.32-7.55) were associated of TIRD. Conclusions The incidence of post-dialysis fatigue is high. Most of the patients require more rest or sleep immediately after dialysis. The level of lactic acid is a significant influencing factor of the fatigue of patients. TIRD is correlated with the elevation of lactic acid during the dialysis process, and more attention should be paid to post-dialysis fatigue.     

血液透析患者的动脉僵硬度及相关因素

目的 研究维持性血液透析（MHD）患者的动脉僵硬度并探讨相关影响因素。 方法 采用Complior SP 脉搏波速度（PWV）测定仪测定MHD患者单次透析前后颈动脉-股动脉PWV（CFPWV）和颈动脉-桡动脉PWV（CRPWV）。检测相关血生化指标和全段甲状旁腺素（iPTH）水平。多元逐步回归方法分析影响PWV的因素。配对t检验比较单次透析前后PWV的变化。36例性别、年龄匹配的健康成人作为对照。 结果 入选患者90例，男性48例，女性42例，平均年龄（59.8±14.5）岁，平均透析龄（29.4±28.8）个月。CFPWV为（13.22±3.23） m/s，CRPWV为（9.58±1.87） m/s，均高于健康对照（P < 0.05）。多元逐步回归分析结果显示，年龄和脉压是CFPWV的独立影响因素；透析龄、钙磷乘积、iPTH、低密度脂蛋白和平均动脉压是影响CRPWV的因素。单次透析前后PWV差异无统计学意义。 结论 MHD患者存在大、中动脉弹性的下降，年龄和脉压是大动脉僵硬度的影响因素。中等肌性动脉僵硬度更易受透析相关指标的影响。     

Muscle mass evaluation and influential factors of sarcopenia in maintenance hemodialysis patients

Objective To evaluate the muscle mass in maintenance hemodialysis (MHD) patients and analyze the influential factors. Methods Ninety-seven patients on MHD and 34 healthy people were recruited. Muscle mass was measured by bioelectrical impedance analysis and compared. Patients'age, sex, height, body weight, walking activity, modified quantitative subjective global assessment (MQSGA) score and laboratory tests were recorded. The relationship of appendicular skeletal muscle mass/height2 (ASM/H2) and other factors were analyzed using multivariate linear regression. Results Compared with normal cohort, the MHD patients showed lower body fat rate and lower ASM/H2 (both P＜0.05). In 97 MHD patients, 21.4% of male patients suffered from sarcopenia, and 24.4% of female patients suffered from sarcopenia. Patients were divided into two groups according to the level of ASM/H2 (male＜7.0 kg/m2, female＜5.8 kg/m2). The grip strength, serum creatinine, 1,25(OH)2D and mid-arm muscle circumference in low ASM/H2 group were lower than those in normal ASM/H2 group, and the differences were significant (all P＜0.05). In multivariable regression model, male (β=0.534, P=0.003), 1,25(OH)2D (β=0.582, P=0.024), creatinine (β=0.421, P=0.037), grip strength (β=0.681, P=0.001), and lg[NT-proBNP] (β=-1.760, P=0.042) were independently associated with ASM/H2 in MHD patients. Conclusion The prevalence of sarcopenia is much higher in MHD patients than in healthy people. The levels of grip strength, NT-proBNP, creatinine and 1, 25(OH)2D are the important influential factors for muscle mass in MHD patients.     

Incidence of cognitive impairment and risk factors associated with prognosis in maintenance hemodialysis patients

Objective To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients. Methods The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014, ≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA＜26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis. Results A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6%. There were 130 males, and the ratio of male to female was 1.46∶1. Age was (60.07±12.44) years old and dialysis vintage was (100.79±70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status＜12 years, history of diabetes and anuria (all P＜0.05); however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P＜0.05). Multivariate logistic regression analysis showed that education status＜12 years (OR=3.428, 95%CI 1.919-6.125, P＜0.001), post-dialysis diastolic pressure＜73 mmHg (OR=2.234, 95%CI 1.253-3.984, P=0.006) and spKt/V＜1.72(OR=1.982, 95%CI 1.102-3.564, P=0.022) were the independent risk factors for cognitive impairment in MHD patients. The Kaplan-Meier survival curve analysis showed that the survival rate of patients with cognitive impairment was lower than that of non-cognitive impairment group in MHD patients during 3 years follow-up (χ2=3.977, P=0.046). Multivariate Cox regression analysis showed that cognitive impairment was an independent risk factor for death in MHD patients (RR=2.661, 95%CI 0.967-7.321, P=0.058). Conclusions Cognitive impairment is one of the common complications and an independent risk factor for death in MHD patients. The mortality is high in patients who suffer cognitive impairment. Education status ＜12 years, post-dialysis diastolic pressure＜73 mmHg and spKt/V＜1.72 are the independent risk factors for cognitive impairment in MHD patients.     

Analysis of early mortality and related risk factors in maintenance hemodialysis patients

Objective To analyze the early mortality and related risk factors of new hemodialysis patients in Zhejiang province, and provide basis for reducing the death risk of hemodialysis patients. Methods The early mortality and related factors of new hemodialysis patients from January 1, 2010 to June 30, 2018 were retrospectively analyzed using the database of Zhejiang province hemodialysis registration. The early mortality was defined as death within 90 days of dialysis. Cox regression model was used to analyze the related risk factors of the early mortality in hemodialysis patients. Results The mortality was the highest in the first month after dialysis (46.40/100 person year), and gradually stabilized after three months. The early mortality was 25.33/100 person year. The mortality within 120 days and 360 days were 21.40/100 person year and 11.37/100 person year, respectively. The elderly (≥65 years old, HR=1.981, 95%CI 1.319-2.977, P＜0.001), primary tumor (HR=3.308, 95%CI 1.137-5.624, P=0.028), combined with tumors (not including the primary tumor, HR=2.327, 95%CI 1.200-4.513, P=0.012), temporary catheter (the initial dialysis pathway, HR=3.632, 95%CI 1.806-7.307, P＜0.001), lower albumin (＜30 g/L, HR=2.181, 95%CI 1.459-3.260, P＜0.001), lower hemoglobin (every 0.01 g/L increase, HR=0.861, 95%CI 0.793-0.935, P=0.001), lower high density lipoprotein (＜0.7 mmol/L, HR=1.796, 95%CI 1.068-3.019, P=0.027) and higher C reactive protein (≥40 mg/L, HR=1.889, 95%CI 1.185-3.012, P=0.008) were the risk factors of early death for hemodialysis patients. Conclusions The early mortality of hemodialysis patients is high after dialysis, and gradually stable after 3 months. The elderly, primary tumor, combined with tumors, the initial dialysis pathway, lower albumin, lower hemoglobin, lower high density lipoprotein and higher C reactive protein are the risk factors of early death for hemodialysis patients.     

维持性血液透析患者睡眠质量及其影响因素的研究

目的 调查维持性血液透析(MHD)患者的睡眠状况,了解影响MHD患者睡眠质量的相关因素.方法 采用方便抽样方法,抽取中山大学附属第一医院、中山大学附属第二医院、广东省东莞市东华医院、江门市新会区人民医院、河源市人民医院、佛山市顺德区中医院及云南省楚雄市人民医院的MHD患者424例为研究对象.以匹茨堡睡眠质量指数量表( PSQI)、不安腿综合征诊断及评分标准、社会支持评定量表、综合主观性营养评估、家庭关怀度指数问卷、疾病家庭负担量表及自设的一般情况调查表调查MHD患者的睡眠状况并分析其影响因素.结果 395例(93.2％)患者PSQI总分≥5分.家庭关怀度及社会支持与睡眠指数得分呈负相关(r=-0.133,P=0.006;r=-0.105,P=0.031).疾病负担与睡眠指数得分呈正相关(r=0.215,P=0.000).营养状况(F=46.123,P=0.000)、不安腿综合征(F=9.392,P=0.000)、睡眠呼吸暂停综合征(F=5.645,P=0.001)与睡眠指数得分密切相关.结论 MHD患者睡眠质量差的发生率相当高,其睡眠质量与家庭关怀度、社会支持等多个因素相关.     

维持性血液透析与腹膜透析患者左心室功能及相关因素分析

目的针对维持性肾脏替代治疗患者左心室功能情况及相关因素进行分析。方法将264例患者按不同肾脏替代治疗方式分为血液透析组（A组）和腹膜透析组（B组）,并常规检测血肌酐（SCr）、尿素氮（BUN）、血浆白蛋白（Alb）、血红蛋白（Hb）、血钙、血磷、血总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血全段甲状旁腺激素（iPTH）,超敏C反应蛋白（hs-CRP）;高压液相方法检测血浆同型半胱氨酸（Hey）;利用超声心动检查评价左心室功能。结果2组中,A组Hb、TG高于B组（P〈0．05）,而BUN低于B组（P〈0．05）;B组左心室舒张功能异常发生率高于A组（P〈0．01）;A组室间隔厚度、后壁厚度低于B组,而左室舒张末内径、左室收缩末内径及舒张早期和舒张晚期二尖瓣121最大血流速度之比（E／A）及射血分数（EF）高于B组,但只有舒张早期和舒张晚期二尖瓣口最大血流速度之比（E／A）有统计学差异（P〈0．01）;多因素Logistic回归分析显示,Alb、尿酸（UA）、hs—CRP、血钙、血磷水平是。肾脏替代治疗患者左室收缩功能障碍的危险因素;而年龄及收缩压与舒张压是其患者左室舒张功能障碍的危险因素。结论不同肾脏替代治疗方式下,患者左心室舒张功能异常发生率存在差异,纠正低蛋白血症,增加透析剂量,控制血压,减轻心脏负荷,纠正钙磷水平可能有助于改善其患者左心室功能异常。     

Clinical characteristic and correlative factors of maintenance hemodialysis patients with restless legs syndrome

Objective To explore the prevalence and the correlative factors of restless legs syndrome (RLS) in maintenance hemodialysis (MHD) patients. Methods The basic information and clinical laboratory results of 307 MHD patients were collected. The international RLS study group (IRLSSG) diagnostic criteria were applied to assess the presence and the severity of RLS. Binary logistic analysis was used for exploring correlative factors of RLS. Results The prevalence of RLS was 12.1% in the MHD patients, with 73.0% patients having mild-to-moderate symptoms and 83.8% having chronic RLS. There was no significant difference between MHD patients with and without RLS in age, gender, dialysis age, daily urine, Kt/V, history of smoking, drinking, hemoglobin, serum creatinine, urea nitrogen, uric acid, calcium, phosphorus, magnesium, potassium, intact parathyroid hormone (iPTH), prealbumin, albumin and alkaline phosphatase. But the frequency of daily exercise in RLS group is significantly lower than that in non-RLS group (Z=-4.114, P＜0.001). Logistic regression analysis showed that daily exercise was a correlative factor of RLS (B=-2.203, OR=0.111, 95%CI 0.033-0.371, P＜0.001). Conclusions RLS is a common complication in MHD patients, with chronic state and mild-to-moderate symptoms. RLS is correlated with daily exercise, which may be a scientific approach to treat or prevent this disease.     

血液透析患者动脉弹性功能及相关因素分析

目的探讨维持性血液透析（MHD）患者在血液透析前、后脉搏波速度（PWV）和压力反射波增强指数（AIx）水平变化及其相关因素。方法选择92例MHD患者,采用标准袖带水银血压计测量非动脉一静脉内瘘侧上臂坐位血压,动脉脉搏波分析仪检测动脉弹性指数AIx和PwV,并分别与各因素进行单因素相关分析和多元逐步回归分析。结果血液透析患者的袖带血压、中心动脉压、PWV和AIx在血液透析前后均无显著性变化（P〉0．05）;多元逐步回归分析表明,AIx与患者的年龄、性别、主动脉收缩压有明显相关（P〈0．05）,而PWV与患者年龄、上臂舒张压、钙磷乘积、身高、透析时间和心率存在明显相关（P〈0．05）;PWV与AIx之间有明显相关（P〈0．05）。结论（1）血液透析患者的AIx与PWV、中心动脉压收缩压（C_SP）、身高、血清白蛋白、性别和年龄存在相关关系,其中与PWV、性别、年龄和C_SP呈正相关;而与身高和血清白蛋白呈负相关。（2）血液透析患者的PWV与AIx、年龄、舒张压、钙磷乘积、身高、透析时间和心率存在相关关系,其中与AIx、年龄、钙磷乘积、舒张压、透析时间及心率呈正相关,仅与身高呈负相关。     

Clinical characteristics and risk factors of infection-related hospitalization in maintenance hemodialysis patients

Objective To explore the clinical characteristics and risk factors of maintenance hemodialysis (MHD) patients combined with infection-related hospitalization. Methods Patients with MHD from December 1, 2013 to February 28, 2018 were retrospectively selected and then followed up for at least 1 year until February 28, 2019. Baseline data including demographic and clinical data of patients were collected. According to whether the infection-related hospitalization occurred, patients were divided into infection group and non-infection group. The clinical characteristics and related factors were compared between the two groups. Logistic regression model was used to analyze the influencing factors. Results A total of 392 patients were included in the study. Two hundred and fifty-five cases were males, accounting for 65.1%. The age was (59.39±15.28) years old. The infection rate of diabetic kidney disease patients was the highest (32.2%). The main site of infection was the lung, accounting for 78.4%, which was far higher than the catheter-related infection in the second position. After infection, quinolones and cephalosporins were often the preferred drugs. Compared with the non-infection group, the infection group had older age [(62.96±15.16) years vs (57.98±15.12) years, t=-2.607, P=0.004], higher proportion of comorbid diabetes (45.9% vs 32.4%, χ2=6.334, P=0.012) and previous smoking history (30.6% vs 18.5%, χ2=6.831, P=0.009), longer time of first dialysis stay [13.0(9.0, 18.0) d vs 12.0(9.0, 17.5) d, Z=3.659, P=0.001] and lower hemoglobin [(74.43±19.93) g/L vs (79.06±17.10) g/L, t=1.612, P=0.022] , albumin [(32.63±5.33) g/L vs (33.99±6.14) g/L, t=2.062, P=0.029] and red blood cell count [2.53×1012/L (2.06×1012/L, 3.06×1012/L) vs 2.68×1012/L(2.28×1012/L, 3.07×1012/L), Z=2.118, P=0.034]. Multivariate logistic analysis found that older age (every 1 year, OR=1.016, 95%CI 1.003-1.030, P=0.017) and longer hospital stay at first dialysis (every 1 d, OR=1.047, 95%CI 1.014-1.080, P=0.008) were independent risk factors, and higher hemoglobin (every 1 g/L, OR=0.987, 95%CI 0.975-0.999, P=0.033) was a protective factor for infection-related hospitalization in MHD patients. Conclusions MHD patients with diabetic kidney disease have the highest infection incidence. The incidence of pulmonary infection is much higher than other types of infection such as catheter-related infection, urinary tract infection and sepsis. Aging and low hemoglobin are risk factors for MHD patients to prone to co-infection.     

维持性血液透析患者的静息能量消耗特点

目的 探讨维持性血液透析(MHD)患者的静息能量消耗特点.方法 选择我院行MHD的终末期肾脏疾病(ESRD)患者50例,采用呼吸间接测热法测量患者实际的静息能量消耗(REE)值,与国际上通用的健康成人的Harris-Benedict公式的计算值比较,使用Spearman相关、配对t检验、吻合比例进行统计分析.结果 MH...     

青年维持性血液透析患者心血管疾病调查及危险因素分析

目的调查青年维持性血液透析（MHD）患者心血管疾病的发病情况和病变特点，并探讨其危险因素。方法采用横断面研究。MHD患者98例，以45岁为界分为青年组（47例）和中老年组（51例）。收集患者临床资料和生化指标。心脏超声检查测量心脏腔径及心功能参数。分析青年组患者心脏结构和功能异常的患病率、病变特点及其影响因素。结果（1）47例青年患者中有30例（63．8％）存在心脏结构异常，主要表现为左心室肥厚、左心房增大和瓣膜反流，患病率分别为61．7％、38．3％和34．0％。（2）青年组患者向心性肥厚的患病率为86．2％，离心性肥厚的患病率为13．8％，与中老年组相比，差异有统计学意义（P〈0．05）。（3）与无心脏病变青年MHD患者相比，伴心脏病变者的超滤量、收缩压、血磷和甲状旁腺激素明显增高，而Kt／V、血红蛋白和血清白蛋白明显降低，差异有统计学意义（P〈0．05）。Logistic回归分析结果显示，超滤量、收缩压、血红蛋白和血甲状旁腺激素是青年MHD患者并发心脏病变的独立危险因素。结论青年MHD患者心血管疾病的患病率较高，主要表现为左心室肥厚、左房增大和瓣膜反流。超滤量、收缩压、血红蛋白和血甲状旁腺激素水平可能是影响青年MHD患者并发心脏病变的独立危险因素。     

维持性血液透析患者动脉粥样硬化的早期诊断及相关因素研究

显著的影响.MHD患者桡动脉内膜厚度显著厚于对照组(P＜0.05),与颈动脉IMT呈正相关(P＜0.01).有斑块患者IMT及心血管并发症的发生率高于无斑块患者(P＜0.01).结论 MHD患者颈动脉粥样硬化发生率高,微炎症状态是其发生的重要影响因素.     

维持性血液透析患者动脉粥样硬化的早期诊断及相关因素研究

t plaques (p ＜ 0.01). Conclusions The incidence rate of AS of arteria carotis is.high in MHD patients. Micro -inflammatory state is an important factor influencing the incidence rate of AS of arteria carotis.     

维持性血液透析患者心脏结构功能的危险因素分析

目的探讨影响维持性血液透析（MHD）患者心脏结构功能的危险因素。方法选择MHD患者153例,超声心动图测定心脏各项指标,并计算左心室心肌重量指数（LVMI）。生存函数乘积限（Kaplan-Meier）分析观察LVMI对患者预后的影响,分析影响LVMI的危险因素关系。结果153例MHD患者中,84例（占55．2％）患者存在左心室肥厚。多元回归结果显示超滤量（UF）和血红蛋白是影响左心室肥厚的独立危险因素。每周3次透析与每周2次透析的患者左心室肥厚的发生率分别为59．3％和52．1％。Kaplan-Meier生存分析显示左心室肥厚患者的5、10和15年生存率分为78．3％、54．3％和36．2％。结论MHD患者存在较高的左心室肥厚发生率,UF、血红蛋白与左心室肥厚相关,预防患者左心室肥厚可能有助于提高患者生存率。     

3种透析方式对于维持性血液透析患者难治性高血压的疗效观察

目的观察血液透析、血液透析并滤过和血液透析＋血液透析并滤过3种血液净化治疗方法对维持性血液透析患者难治性高血压的临床疗效。方法将60例维持性血液透析患者随机分为3组,即血液透析组、血液透析并滤过组和血液透析＋血液透析并滤过组各20例。血液透析组每周行血液透析治疗3次;血液透析并滤过组每周行血液透析并滤过治疗3次;血液透析＋血液透析并滤过组每周行血液透析治疗2次,血液透析并滤过治疗1次。观察治疗4周和8周后血压的变化。结果血液透析组治疗4周和8周后和治疗前相比,患者血压差异无统计学意义（P〉0．05）;血液透析并滤过组和血液透析＋血液透析并滤过组中,治疗4周后两组血压都较本组治疗前明显下降（P〈0．05）;但两组间比较,差异均无统计学意义（P〉0．05）;治疗8周与治疗4周时相比,两组患者血压均基本保持稳定,没有明显进一步下降,差异无统计学意义（P〉0．05）。结论血液透析＋血液透析并滤过及血液透析并滤过两种血液净化方式均可以有效改善血液透析患者难治性高血压,而且血液透析＋血液透析并滤过比血液透析并滤过方式更为经济。     

鲑鱼降钙素对维持性血液透析患者并发高钙血症的疗效观察

目的观察鲑鱼降钙素治疗维持性血液透析（MHD）患者并发高钙血症的疗效。方法对28例MHD患者合并高钙血症者给予鲑鱼降钙素肌肉注射,开始每天1次,连续6d,以后每周2次,透析后使用。疗程12周。以用药前和用药后第2、4、8、12周检测血钙、血磷、钙磷乘积和血全段甲状旁腺素（iPTH）为指标,应用视觉模拟疼痛评分法对骨关节疼痛程度进行定量,并进行统计学分析。结果25例完成观察。治疗后第4周血钙、钙磷乘积均有不同程度降低,与治疗前比较有统计学意义（P〈0．05）;血磷和iPTH也有降低,但与治疗前比较差异无显著性。治疗后第4周,所有患者骨关节疼痛、活动障碍等症状均有不同程度缓解;疗程结束后23例症状基本消失,但治疗前已发生的转移性钙化等现象无变化。结论鲑鱼降钙素治疗MHD患者并发高钙血症,可以有效降低高血钙、钙磷乘积,并能够有效缓解骨关节疼痛症状,近期疗效显著。     

维持性血液透析患者心血管钙化的发生率及相关因素

目的 探讨维持性血液透析患者心血管钙化的发生率及相关因素.方法 选择接受维持性血液透析≥3月的非住院患者60例,完善相关实验室检查,腹部侧位X线片检测腹主动脉钙化评分(Kauppila法),心脏超声检测心脏瓣膜钙化情况,并计算心血管钙化指数.结果 本组患者影像学检查可见钙化的总发生率为68.3％,腹主动脉钙化的患者中5≤腹主动脉钙化评分＜ 16者占41.4％,瓣膜钙化以主动脉瓣为主(占64.5％).有钙化组与无钙化组患者的年龄、血钙、心血管钙化指数存在差异(均P ＜0.05),而透析龄(月)、身高、体质量、握力、血磷、血红蛋白、血清总蛋白、血清白蛋白、血脂未见差异(均P≥0.05).结论 本组患者心血管钙化部位不均衡,随患者年龄和血钙水平的增加,心血管钙化的发生风险升高.     

Epidemiological investigation of hypertension and its control on maintenance hemodialysis patients in Anhui province

Objective To understand the prevalence, treatment and influence factors of hypertension in maintenance hemodialysis (MHD) patients in Anhui Province. Methods A total of 2724 adult patients on MHD from January 1st 2014 to March 31st 2014 in 26 hospitals of southern, northern and central Anhui Province were investigated. Their demographic characteristics, primary disease, complications, medications, dialysis and laboratory examination were explored. The prevalence treatment rate and control rate of hypertension were analyzed. Associated factors for controlling hypertension [systolic blood pressure (SBP)＜140 mmHg and diastolic blood pressure (DBP)＜90 mmHg] were assessed by logistic regression analysis. Results (1) The prevalence of hypertension in the hemodialysis patients was 87.0%. Their treatment rate and control rate were 93.2% and 23.9% respectively. The average of SBP was (145.90±21.18) mmHg, and the DBP on average was (83.60±12.21) mmHg. The most commonly used anti-hypertensive drug is calcium channel blocker (88.2%). Over one third (45.7%) of patients were treated with two kinds of anti-hypertensive drug, 26.2% with 1 kind, 21.7% with 3 kinds, and 6.4% with 4 kinds or more. (2) Compared with non-hypertension patients, patients with hypertension have older age, higher body mass index (BMI), phosphorus, SBP and DBP, as well as lower hemoglobin and Kt/V (all P＜0.05). (3) The multivariate logistic regression analysis showed that Ca＞2.50 mmol/L (OR=2.084, 95%CI 1.008-4.307, P=0.047) positively correlated with controlling hypertension, while smoke (OR=0.594, 95%CI 0.356-0.911, P=0.046) and BMI 18.5～23.9 kg/m2 (OR=0.516, 95%CI 0.293-0.907, P=0.022) negatively correlated with it. Conclusions High prevalence yet low control rate of hypertension in MHD patients in Anhui Province were observed. Hypocalcemia may be a protective factor for hypertension control, while smoke and BMI may be risk factors for it.