Abstract
Background
Chronic kidney disease-mineral bone disorder (CKD-MBD) is a common comorbidity in patients with CKD. The study aims to describe the control rates of serum-corrected calcium (Ca), phosphate (P) and intact parathyroid hormone (iPTH) and its risk factors among maintenance hemodialysis (MHD) patients in Anhui Province of China.
Methods
The study was conducted in 27 hemodialysis centers of Anhui Province between January 1st 2020 and December 31th 2020. Chi-square test was used to compare the control rates of serum-corrected Ca, P and iPTH between the present study and DOPPS 4 or Anhui Province in 2014. Binary logistic regression analysis was used to explore the risk factors of the control rates of serum-corrected Ca, P and iPTH.
Results
A total of 3 025 MHD patients were recruited in this study, with a mean age of 54.8 (SD: 12.8) years, and 60.1% were males. According to the Chinese Diagnosis and Treatment Guidelines for CKD-MBD, the control rates of serum-corrected Ca, P and iPTH in the present study were 57.9%, 20.0% and 56.0%, respectively. Based on KDOQI guidelines (2003), the control rates of the above indicators were 43.1%, 35.3% and 22.3%, respectively. The control rates of serum-corrected Ca, P and iPTH in this study were lower than those of DOPPS 4 (P < 0.001). Compared to the results of Anhui Province in 2014, the control rate of corrected Ca was higher (P < 0.001) and the control rate of iPTH was lower (P = 0.005). Age, residential area, BMI, dialysis vintage, albumin and hemoglobin levels were factors of serum-corrected Ca, P and iPTH not within target range.
Conclusion
The control rates of serum-corrected Ca, P and iPTH in MHD patients in Anhui Province are relatively low. Monitoring and management should be strengthened to improve the prognosis of patients undergoing dialysis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Chen H, Wang DG, Qian GR, Huang YY, Hu B, Wang CF et al (2015) Investigation of maintenance hemodialysis patients with mineral and bone disorder in Anhui Province. Chin J Nephrol 31(7):509–515. https://doi.org/10.3760/cma.j.issn.1001-7097.2015.07.006
Zhang L, Zhao MH, Zuo L, Wang Y, Yu F, Zhang H et al (2019) China kidney disease network (CK-NET) 2015 annual data report. Kidney Int Suppl 9(1):e1–e81. https://doi.org/10.1016/j.kisu.2018.11.001
Zhang L, Zhao MH, Zuo L, Wang Y, Yu F, Zhang H, Wang H, CK-NET Work Group (2020) China kidney disease network (CK-NET) 2016 annual data report. Kidney Int Suppl 10(2):e97–e185. https://doi.org/10.1016/j.kisu.2020.09.001
National Clinical Research Center For Kidney Disease (2019) Summary of Chinese guidelines for the diagnosis and treatment of chronic kidney disease with mineral and bone abnormalities in. J Nephrol Daily Transplant 28(1):52–57. https://doi.org/10.3969/j.issn.1006-298X.2019.01.012
Fernández-Martín JL, Martínez-Camblor P, Dionisi MP, Floege J, Ketteler M, London G et al (2015) Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study. Nephrol Dial Transplant 30(9):1542–1551. https://doi.org/10.1093/ndt/gfv099
Lamina C, Kronenberg F, Stenvinkel P, Froissart M, Forer L, Schönherr S et al (2020) Association of changes in bone mineral parameters with mortality in haemodialysis patients: insights from the ARO cohort. Nephrol Dial Transplant 35(3):478–487. https://doi.org/10.1093/ndt/gfz060
Zhao X, Niu Q, Gan L, Hou FF, Liang X, Ni Z et al (2021) Baseline data report of the China Dialysis Outcomes and Practice Patterns Study (DOPPS). Sci Rep 11:873. https://doi.org/10.1038/s41598-020-79531-4
Alicic RZ, Rooney MT, Tuttle KR (2017) Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol 12(12):2032–2045. https://doi.org/10.2215/CJN.11491116
Zhang XX, Kong J, Yun K (2020) Prevalence of diabetic nephropathy among patients with type 2 diabetes mellitus in china: a meta-analysis of observational studies. J Diabetes Res 2020:2315607. https://doi.org/10.1155/2020/2315607
Hou JH, Zhu HX, Zhou ML, Le WB, Zeng CH, Liang SS et al (2018) Changes in the spectrum of kidney diseases: an analysis of 40,759 Biopsy-proven cases from 2003 to 2014 in China. Kidney Dis (Basel) 4:10–19. https://doi.org/10.1159/000484717
Jiang Y, Lu XQ, Liang XH, Qiao YJ, Wang P (2020) Investigation of bone and mineral metabolism in hemodialysis patients treated in primary hospitals. Chin J Blood Purif 19(4):225–229. https://doi.org/10.3969/j.issn.1671-4091.2020.04.003
Rastogi A, Bhatt N, Rossetti S, Beto J (2021) Management of hyperphosphatemia in end-stage renal disease: a new paradigm. J Ren Nutr 31(1):21–34. https://doi.org/10.1053/j.jrn.2020.02.003
Lu RH, Ni ZH, Qian JQ, Zhang Z, Yuan WJ, Rong S et al (2013) Efficacy and safety of calcium acetate on hyperphosphatemia in patients undergoing hemodialysis. Chin J Nephrol 29(6):429–434. https://doi.org/10.3760/cma.j.issn.1001⁃7097.2013.06.006
Komaba H, Wang M, Taniguchi M, Yamamoto S, Nomura T, Schaubel DE et al (2017) Initiation of sevelamer and mortality among hemodialysis patients treated with calcium-based phosphate binders. Clin J Am Soc Nephrol 12(9):1489–1497. https://doi.org/10.2215/CJN.13091216
Qi YH, Qu XL, Du ML, Zhang SB, Qiao C, Wang XY et al (2017) Effect of continuous quality improvement on mineral bone metabolism in maintenance hemodialysis patients. Chin J Blood Purif 16(8):533–536. https://doi.org/10.3969/j.issn.1671-4091.2017.08.008
Dou LB, Cai H, Zhang WM, Zhu ML, Lu RH, Lu JY et al (2015) Retrospective analysis of calcium and phosphorus metabolism disturbances in maintenance hemodialysis patients. Chin J Blood Purif 14(7):412–417. https://doi.org/10.3969/j.issn.1671-4091.2015.07.008
Zhu JR, Zhang F, Zhang XY, Su CY (2015) The present status and the related factors of abnormal calcium- phosphorous metabolism in maintenance hemodialysis patients. Chin J Blood Purif 14(8):478–481. https://doi.org/10.3969/j.issn.1671-4091.2015.08.009
Chen S, Zhang GJ, Jiang LP, Huang W (2016) The difference of bone metabolism markers in maintenance hemodialysis patients from central city and countryside of Beijing. Chin J Blood Purif 15(2):121–123. https://doi.org/10.3969/j.issn.1671-4091.2016.02.017
Chen X, Wang JX, Guo QQ, Ma WW, Ning XY (2017) Retrospective analysis of hemodialysis and peritoneal dialysis on calcium and phosphorus metabolism disturbances in patients with end stage renal disease. Chin Gen Pract 20(S2):1–5
Li W, Zhang S (2015) Risk factors of parathyroid dysfunction in elderly patients with chronic kidney disease undergoing hemodialysis. Adv Clin Exp Med 24(6):1007–1012. https://doi.org/10.17219/acem/23439
Sprague SM, Martin KJ, Coyne DW (2021) Phosphate balance and CKD-mineral bone disease. Kidney Int Rep 6(8):2049–2058. https://doi.org/10.1016/j.ekir.2021.05.012
Yao J, Xu LF, Wu CL, Wu J, You GQ (2020) Effects of dietary health education on dietary management behavior, calcium and phosphorus metabolism and nutritional status of maintenance hemodialysis patients. Chin J Health Educ 36(12):1141–1144. https://doi.org/10.16168/j.cnki.issn.1002-9982.2020.12.019
Lin FJ, Zhang X, Huang LS, Ji G, Huang HD, Xie Y, Jiang GR, Zhou X, Lu W (2018) Impact of hemoglobin variability on cardiovascular mortality in maintenance hemodialysis patients. Int Urol Nephrol 50(9):1703–1712. https://doi.org/10.1007/s11255-018-1919-5
Cozzolino M, Ciceri P, Galassi A (2019) Hyperphosphatemia: a novel risk factor for mortality in chronic kidney disease. Ann Transl Med 7(3):55. https://doi.org/10.21037/atm.2018.06.50
Hiyamuta H, Yamada S, Taniguchi M, Tokumoto M, Tsuruya K, Nakano T et al (2021) Association of hyperphosphatemia with an increased risk of sudden death in patients on hemodialysis: Ten-year outcomes of the Q-Cohort Study. Atherosclerosis 316:25–31. https://doi.org/10.1016/j.atherosclerosis.2020.11.020
Shimamoto S, Yamada S, Hiyamuta H, Arase H, Taniguchi M, Tokumoto M et al (2020) Association of serum phosphate concentration with the incidence of intervention for peripheral artery disease in patients undergoing hemodialysis: 10-year outcomes of the Q-Cohort Study. Atherosclerosis 304:22–29. https://doi.org/10.1016/j.atherosclerosis.2020.04.022
Yamada S, Tsuruya K, Taniguchi M, Tokumoto M, Fujisaki K, Hirakata H et al (2016) Association between serum phosphate levels and stroke risk in patients undergoing hemodialysis: The Q-Cohort Study. Stroke 47(9):2189–2196. https://doi.org/10.1161/STROKEAHA.116.013195
Melamed ML, Eustace JA, Plantinga L, Jaar BG, Fink NE, Coresh J et al (2006) Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: a longitudinal study. Kidney Int 70(2):351–357. https://doi.org/10.1038/sj.ki.5001542
Li D, Liu W, Huang H, Guo W, Diao Z, Chen X et al (2021) Association between the risk of death and serum calcium, phosphate, and intact parathyroid hormone levels in older patients undergoing maintenance hemodialysis: a cohort study in Beijing. Ther Adv Endocrinol Metab 12:20420188211025160. https://doi.org/10.1177/20420188211025161
Soohoo M, Feng M, Obi Y, Streja E, Rhee CM, Lau WL et al (2016) Changes in markers of mineral and bone disorders and mortality in incident hemodialysis patients. Am J Nephrol 43(2):85–96. https://doi.org/10.1159/000444890
Acknowledgements
Sincerely appreciate to all patients for providing informed consent and information. Thanks to all who doctors, nurses and researchers involved in the study for their inputs.
Funding
The study was funded by Science Foundation of Anhui Medical University (2019xkj140), Clinical Research Incubation Program of The Second Hospital of Anhui Medical University (2020LCZD01) and Co-construction project of clinical and preliminary disciplines of Anhui Medical University (2020lcxk022, 2021lcxk032).
Author information
Authors and Affiliations
Contributions
ST wrote the main manuscript, and was responsible for data management and formal analysis. XL, ZL, YB, GQ, HW, JL, YG, SY, LC, JY, JH, SM, JY, LY, RS, XJ, HW, FZ, TC, XL, XZ, LL, JF, WW, YZ, and GS were responsible for investigation and data collection. DW was responsible for project administration and funding acquisition.
Corresponding author
Ethics declarations
Conflict of interest
All the authors declared no competing interests.
Ethical approval
This study was approved by the Ethics Committee of The Second Hospital of Anhui Medical University (No. PJ-YX2020-006). Electronic informed consents were obtained from all participants before completing the survey. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Tao, S., Li, X., Liu, Z. et al. Investigation on maintenance hemodialysis patients with mineral and bone disorder in Anhui province, China. Int Urol Nephrol 55, 389–398 (2023). https://doi.org/10.1007/s11255-022-03328-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-022-03328-9