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Open Access Highly Accessed Research article

Mineral and bone disorder in Chinese dialysis patients: a multicenter study

Xianglei Kong126, Luxia Zhang1, Ling Zhang2, Nan Chen3, Yong Gu4, Xueqing Yu5, Wenhu Liu6, Jianghua Chen7, Liren Peng8, Weijie Yuan9, Hua Wu10, Wei Chen11, Minhua Fan12, Liqun He13, Feng Ding14, Xiangmei Chen15, Zuying Xiong16, Jinyuan Zhang17, Qiang Jia18, Wei Shi19, Changying Xing20, Xiaoling Tang21, Fanfan Hou22, Guiyang Shu23, Changlin Mei24, Li Wang25, Dongmei Xu26, Zhaohui Ni27, Li Zuo1, Mei Wang12829* and Haiyan Wang1

Author Affiliations

1 Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China

2 Department of Nephrology, China-Japan Friendship Hospital, Beijing, China

3 Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China

4 Renal Division, Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China

5 Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

6 Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

7 Kidney Diseases Center, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

8 Department of Nephrology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

9 Department of Nephrology, Shanghai First People s Hospital, Shanghai Jiaotong University, Shanghai, China

10 Department of Nephrology, Beijing Hospital, Beijing, China

11 Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China

12 Department of Nephrology, Peking University Third Hospital, Beijing, China

13 Department of Nephrology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China

14 Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China

15 Department of Nephrology, The General Hospital of the People's Liberation Army, Beijing, China

16 Renal Division, Hospital Peking of Shenzhen, Shenzhen, China

17 Department of Nephrology, The 455th Hospital of PLA, Shanghai, China

18 Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China

19 Department of Nephrology, Guangdong General Hospital, Guangzhou, China

20 Renal Division, Jiangsu Provincial Hospital, Nanjing, China

21 Department of internal medicine, Shantou Central Hospital, Shantou, China

22 Department of Nephrology, Nanfang Hospital, The Southern Medical University, Guangzhou, China

23 Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China

24 Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China

25 Department of Nephrology, Sichuan Provincial People’ s Hospital, Chengdu, China

26 Department of Nephrology, Qianfoshan Hospital, Shandong University, Jinan, China

27 Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

28 Department of Nephrology, Peking University People’s Hospital, Beijing, China

29 Institute of Nephrology and Division of Nephrology, and Key Laboratory of Ministry of Health, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China

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BMC Nephrology 2012, 13:116  doi:10.1186/1471-2369-13-116

Published: 21 September 2012

Abstract

Background

Mineral and bone disorder (MBD) in patients with chronic kidney disease is associated with increased morbidity and mortality. Studies regarding the status of MBD treatment in developing countries, especially in Chinese dialysis patients are extremely limited.

Methods

A cross-sectional study of 1711 haemodialysis (HD) patients and 363 peritoneal dialysis (PD) patients were enrolled. Parameters related to MBD, including serum phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH) were analyzed. The achievement of MBD targets was compared with the results from the Dialysis Outcomes and Practice Study (DOPPS) 3 and DOPPS 4. Factors associated with hyperphosphatemia were examined.

Results

Total 2074 dialysis patients from 28 hospitals were involved in this study. Only 38.5%, 39.6% and 26.6% of them met the Kidney Disease Outcomes Quality Initiative (K/DOQI) defined targets for serum P, Ca and iPTH levels. Serum P and Ca levels were statistically higher (P < 0.05) in the HD patients compared with those of PD patients, which was (6.3 ± 2.1) mg/dL vs (5.7 ± 2.0) mg/dL and (9.3 ± 1.1) mg/dL vs (9.2 ± 1.1) mg/dL, respectively. Serum iPTH level were statistically higher in the PD patients compared with those of HD patients (P = 0.03). The percentage of patients reached the K/DOQI targets for P (37.6% vs 49.8% vs 54.5%, P < 0.01), Ca (38.6% vs 50.4% vs 56.0%, P < 0.01) and iPTH (26.5% vs 31.4% vs 32.1%, P < 0.01) were lower among HD patients, compared with the data from DOPPS 3 and DOPPS 4. The percentage of patients with serum phosphorus level above 5.5 mg/dL was 57.4% in HD patients and 47.4% in PD patients. Age, dialysis patterns and region of residency were independently associated with hyperphosphatemia.

Conclusions

Status of MBD is sub-optimal among Chinese patients receiving dialysis. The issue of hyperphosphatemia is prominent and needs further attention.

Keywords:
End stage renal disease; Mineral and bone disorder; Epidemiology