维持性腹膜透析患者血25(OH)D水平及其相关因素分析

目的 了解慢性肾脏病(chronic kidney disease,CKD)5期维持性腹膜透析患者25 (OH)D缺乏与不足的患病率,探讨血清25 (OH)D水平的影响因素,为合理治疗提供依据.方法 选择2010年12月～2011年2月(冬季)期间在北京大学人民医院肾内科规律随访、病情稳定、透析3个月以上的维持性腹膜透析患者进行研究.采用ELISA法检测血清25 (OH)D水平.记录其一般资料、户外活动情况,检测其25 (OH)D水平与矿物质代谢指标(白蛋白校正后的血钙、血磷、iPTH水平)、营养指标(血白蛋白、体质量指数)、血肌酐(SCr)、有无残余肾功能、总尿素清除率(K t/V)等.应用多元线性回归分析25(OH)维生素D水平的影响因素. 结果 101例腹膜透析患者入选,其中男性49例,女性52例,年龄(61.8±14.1)岁,透析龄(25.9±21.7)月,原发病以糖尿病居首位,占40.6％.血清25 (OH)D的水平为(9.92±2.44)ng/ml(5.60～17.83 ng/ml),其中不足的患者占3.96％(4/101),缺乏占96.04％(97/101).原发病为糖尿病的腹膜透析患者25 (OH)D水平明显低于非糖尿病的患者(P＜0.05).多元线性回归结果显示,有无户外活动(β=0.223,P=0.026)、血清校正钙水平(β=0.203,P=0.048)以及有无残肾功能(β=0.267,P=0.012)是25 (OH)D水平的独立影响因素.结论 在北方冬季CKD5期维持性腹膜透析患者中维生素D缺乏/不足的患病率极高.应该注意腹膜透析患者维生素D水平的检测,尤其在糖尿病、残肾功能丧失、低钙血症、户外活动较少的患者中.对于维生素D缺乏/不足者,应该尽早、合理进行维生素D的补充.

Serum 25-hydroxyvitamin D level and its related factors in maintenance peritoneal dialysis patients

Objective To examine the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and insufficiency in CKD patients at stage 5 and on maintenance peritoneal dialysis (PD) and to evaluate the factors relating to serum 25(OH)D level, so as to provide useful bases for appropriate therapy. Methods We recruited 101 maintenance PD patients with stable status and to be regularly followed up for at least three months at the Department of Nephrology, Peking University People’s Hospital from December 2010 to February (winter) 2011. Serum 25(OH)D level was measured by ELISA. Patients’general data were recorded. Serum 25(OH)D level and the parameters of mineral metabolism (serum albumin corrected calcium, phosphorus, intact parathyroid hormone and bone-specific alkaline phosphatase), nutritional index (serum albumin and body mass index), hemoglobin, serum creatinine, residual renal function, total urea clearance (Kt/V), and total creatinine clearance were determined. Multiple linear regression analysis was used to assess the factors relating to serum 25(OH)D level. Results A total of 101 PD patients (49 males and 52 females with a mean age of 61.8±14.1 years) were enrolled in this study. Their average PD duration was 25.9±21.7 months. Their major primary disease was diabetic nephropathy, accounting for 40.6% of the patients. Their average serum 25(OH)D was 9.92±2.44ng/ml (5.60～17.83ng/ml). Vitamin D insufficiency was found in 3.96% (4/101) patients, and vitamin D deficiency in 96.04% (97/101) patients. Serum 25(OH)D were significantly lower in PD patients with diabetes than in those without diabetes (P < 0.05). Multiple linear regression analysis demonstrated that outdoor activities (β= 0.223, P= 0.026), serum albumin corrected calcium level (β= 0.203, P=0.048) and residual renal function (β=0.267, P=0.012) were the independent factors relating to 25(OH)D level. Conclusions Vitamin D deficiency/insufficiency is frequently found in CKD patients at stage 5 undergoing PD in winter in northern China. Hypocalcemia,loss of residual renal function, and less outdoor activities are the independent risk factors relating to vitamin D deficiency/insufficiency. Vitamin D supplement of appropriate dose should be given as early as possible to these patients.