ABSTRACT
Objective To investigate the relationship between mineral and bone metabolic disorders and prognosis in patients with chronic renal disease (CKD).Methods 200 patients with CKD admitted to our hospital from October 2015 to October 2017 were included.The prognosis of the patients was analyzed and grouped according to their prognosis.The follow-up was 6 months.They were divided into good prognosis group (no event survival) and poor prognosis group (complication and death).The clinical characteristics of the two groups were compared,and ROC curves were drawn to analyze the predictive value of mineral and bone metabolic indexes for poor prognosis,including serum calcium (Ca),phosphorus (P),calcium × phosphorus (Ca × P),bone alkaline phosphatase (BSALP),25 hydroxyvitamin D3 [25 (OH) D3],osteocalcin (OC),total parathyroid hormone (iPTH).Logistic regression analysis was used to determine the independent risk factors of poor prognosis in patients with chronic kidney disease.Results Of the 200 patients,164 (82％) had a good prognosis,and 36 (18％) had poor prognosis.The ratio of CKD4,CKD5,poor blood glucose control and poor blood pressure control in the poor prognosis group were 27.78％,16.67％,47.22％,41.67％,respectively,better than the prognosis group (4.27％,1.22％,18.29％,15.85％).The levels of Ca × P,BSALP and OC in the poor prognosis group were (3.46 ±0.21) mmol2/ L2,(98.64 ± 12.67) U/L,(71.19 ±58.73) μg/L,higher than the good prognosis group [(3.34 ±0.28) mmol2/L2,(85.43 ± 15.58) U/L,(36.57 ± 23.65) μg/L];The 25 (OH) D3 level in the poor prognosis group was (11.39 ±6.56) μg/L,which was lower than that in the good prognosis group (19.64 ±8.65) μg/L;with statistically significant difference (P ＜0.05).The area under the curve of Ca × P,BSALP,25 (OH) D3 and OC was 0.782,0.806,0.815 and 0.857,respectively,to predict the poor prognosis of CKD.The logistic regression analysis showed that CKD stage (stage 4-5),poor glycemic control,poor control of blood pressure,Ca × P≥3.393 mmol2/L2,BSAL≥92.932 U/L,25 (OH) D3 ≤ 14.016 μg/L,OC ≥86.339 μg/L were independent risk factors of poor prognosis of CKD (P ＜ 0.05).Conclusions Serum Ca × P,BSALP,25 (OH) D3 and OC levels have certain predictive value for the poor prognosis of CKD.The more serious the mineral and bone metabolism disorders are,the greater the risk of poor prognosis.
ABSTRACT
Objective To investigate mineral bone metabolic conditions of pre-dialysis patients with chronic kidney disease (CKD),and obtain useful information about the management and treatment of CKD.Methods The levels of serum calcium,phosphate,25-HydroxyvitaminD [25 (OH) VitD],and intact parathyroid hormone (iPTH) were compared.Then a correlation analysis was performed for 25 (OH)VitD.Results Hypocalcemia,hyperphosphatemia,secondary hyperparathyroidism and inadequate of 25 (OH) VitD appeared early in CKD2.Deficiency of 25 (OH)VitD was widespread in CKD2 ～ 5.Multiple linear regression analysis showed that 25 (OH) VitD was independently associated with adjusted level of calcium (P =0.002),application of calcium carbonate (P =0.038),and application of calcitriol (P =0.049) (R square =0.360,P =0.000).Conclusions Mineral bone disorder emerges early in CKD2.More attention should be paid to the management of 25 (OH)VitD.