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<p><b>OBJECTIVE</b>To explore the value of baseline serum alkaline phosphatase (ALP) for predicting 2-year fracture in patients with chronic kidney disease (CKD) on maintenance dialysis.</p><p><b>METHODS</b>A total of 139 patients with CKD undergoing maintenance dialysis in our hospital were enrolled in this study. According to the median serum ALP level, the patients were divided into high ALP and low ALP groups. The demographic and clinical data of the patients including dialysis duration, serum calcium level, serum phosphorus level, and serum intact parathyroid hormone level were recorded, and their bone mineral density of the femur and the lumbar spine was measured using dual energy X-ray absorptiometry. The patients were followed up for 2 years and fracture events were recorded. The risk factors of fracture were analyzed using logistic regression analysis, and their predictive value for fracture was analyzed using receiver-operating characteristic (ROC) curve.</p><p><b>RESULTS</b>The mean baseline serum ALP level was 132.55±167.68 U/L in these patients, significantly higher than that in the normal population (=2.816, =0.006). Baseline serum ALP level was negatively correlated with the bone mineral density of the lumbar spine (=-0.203, =0.006) and the femur (=-0.196, =0.021). Fractures occurred in 21 (15.1%) of the patients during the 2-year follow-up, and the fracture rate was significantly higher in patients with high ALP levels. Logistic regression analysis identified serum ALP level as an independent risk factor of fracture (OR: 1.010, =0.001, 95%CI: 1.004-1.016). The areas under the ROC curve were 0.900 and 0.768 for serum ALP level and intact parathyroid hormone level in predicting 2-year fractures, respectively.</p><p><b>CONCLUSIONS</b>Serum ALP may serve as a good indicator for predicting 2-year fractures in patients with CKD on maintenance dialysis.</p>
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Objective To analyze the influence factors of maintenance dialysis patients with carotid plaque and explore its relationship with cardiovascular disease(CVD). Methods 52 patients on peritoneal dialy-sis and 46 patients on maintenance hemodialysis were involved in this study. Bilateral carotid intima-media thick-ness(IMT)and plaque,the related clinical indicators and CVD were recorded. According to the mode of dialysis, carotid plaque,CVD respectively,we divided our population into two groups,and statistical analyses were made between the two groups. Results Age,percentage of male,the number of hypertension and diabetes,blood uric acid ,blood glucose ,the incidence of cardiovascular disease are higher ,but the level of albumin is lower in the carotid plaque group. Binary Logistic Regression analysis showed that hypertension ,albumin and uric acid signifi-cantly influenced carotid plaque formation (P < 0.05). CVD is closely related to the carotid plaque (r = 0.415 , P = 0.000). Left and right IMT value are higher in the patients with CVD (P < 0.01);carotid plaque mainly distributed in the common carotid artery(CCA)and carotid artery bifurcation(BIF),and with the larger number in the patients with CVD(P<0.01). Conclusions Carotid plaque formation is closely related with the occurrence of CVD in maintenance dialysis patients. Hypertension ,albumin and uric acid are risk factors for the formation of carotid plaque,so dialysis patients in addition to maintain the blood pressure and improve nutrition,are also very important to control the level of uric acid.
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Objective To compare different blood purification techniques on serum fibroblast growth factor 23(FGF -23)scavenging effect in patients undergoing maintenance hemodialysis (MHD),in order to choose the best blood purification method for clinical maintenance hemodialysis patients.Methods 60 MHD patients were randomly divided into hemodialysis group (HD),hemodiafiltration group (HDF)and HD +HP group,20 cases in each group. Three groups of patients in the observation 1st start of treatment and observation at the end of the last treatment were detected cacium,phosphorus,FGF -23,intact parathyroid hormone(iPTH).Results After treatment,HD group and HDF group,Ca:t =0.29,P =0.77;P:t =1.65,P =0.11;iPTH:t =16.85,P =0.00;HD group and HD +HP group:Ca:t =0.20,P =0.84;P:t =2.62,P =0.01;iPTH:t =42.64,P =0.00;HDF group and HD +HP group:Ca:t =0.09,P =0.92;P:t =2.18,P =0.04;iPTH:t =31.41,P =0.00.After treatment,FGF -23 in the three groups were decreased significantly than before treatment,and the HD +HP group decreased most significantly(HD group and HDF group,t =4.47,P =0.00;HD group and HD +HP group:t =8.06,P =0.00;HDF group and HD +HP group:t =3.20,P =0.00).Conclusion HD +HP treatment can effectively remove phosphorus maintenance dialysis patients and FGF -23.
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<b>Introduction</b> : In Japan, there are over 300,000 hemodialysis (HD) patients and 6,000 new patients are introduced yearly, a figure which is increasing. It is estimated that 12,000 specialists are needed to provide care for these patients, but there are currently only 4,000 to 7,000 such specialists. There is very little literature regarding the role of generalists in the care of HD patients. In our facility, family physicians provide care for HD patients including managing end stage renal disease (ESRD) with backup support from nephrologists.<br><b>Aims</b> : To explore the possibility of expanding the generalist's role in the care of HD patients by critically reviewing our care using several quality indicators and demographics compared with available literature data.<br><b>Methods</b> : Retrospective chart review.<br><b>Outcome measures</b> : patient demographics, quality indicators including Kt/Vdp, hemoglobin, serum albumin, serum calculated calcium, serum phosphorus, intact-PTH, rates of hospitalization, transfer of care, and death.<br><b>Results</b> : Fifty-two patients were cared for in 2011. The average target achievement rate was 80.0% for Kt/Vdp, 69.9% for hemoglobin, 63.7% for serum albumin, 85.4% for corrected serum calcium, 78.3% for serum phosphorus, and 56.8% for intact-PTH.<br><b>Conclusion</b> : Generalists can contribute to the care of HD/ESRD patients by utilizing appropriate quality assurance training and support, and in turn reduce the work burden of specialists without compromising quality of care.