摘要
目的分析单中心维持性血液透析(maintenance hemodialysis,MHD)患者在不同药物治疗模式下矿物质和骨代谢异常(mineral and bone disorder,MBD)的生化指标、临床事件及相关药品使用费用情况,探讨透析患者MBD优化治疗管理方案。方法根据北京医院血液透析中心不同时期MBD相关药物使用情况,纳入相应时间段的MHD患者。选取2017年1月1—31日151例患者为传统药物按需治疗组,2019年1月1—31日151例患者为新型药物受限治疗组,2020年1月1—31日153例患者为新型药物按需治疗组。3组患者均随访1年,比较3组生化指标、骨痛、临床事件和药品使用费用的情况。结果传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组患者性别、年龄、透析龄和合并糖尿病的比例比较,差异均无统计学意义(P>0.05)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组血钙水平[2.30(2.15,2.43)mmol/L、2.20(2.11,2.34)mmol/L和2.21(2.12,2.30)mmol/L]比较,差异有统计学意义(P<0.001),按照K/DOQI标准的达标率分别为49.0%、57.6%和65.4%,组间比较差异有统计学意义(P=0.016);血磷水平[(1.74±0.51)mmol/L、(1.76±0.50)mmol/L和(1.65±0.44)mmol/L]比较,差异无统计学意义(P=0.081),按照K/DOQI标准的达标率分别为45.0%、43.7%和58.8%,差异有统计学意义(P=0.014);钙磷乘积[49.25(40.13,58.46)、47.42(38.59,55.95)和43.44(35.41,52.62)]比较,差异有统计学意义(P=0.024)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺激素(parathyroid hormone,PTH)水平比较,差异无统计学意义(P=0.465),按照K/DOQI标准PTH达标率分别为24.5%、35.8%和36.6%,按照KDIGO标准PTH达标率分别为51.0%、60.3%和66.0%,组间比较差异均有统计学意义(P=0.042和P=0.048)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组分别有109例(72.2%)、101例(66.9%)和87例(56.9%)患者使用含钙的磷结合剂,有0例(0.0%)、76例(50.3%)和87例(56.9%)患者使用不含钙的磷结合剂,有0例(0.0%)、35例(23.2%)和47例(30.7%)患者使用拟钙剂,差异均有统计学意义(P<0.05)。随访期内3组骨折和心脑血管事件发生率比较,差异均无统计学意义(P=0.703和P=0.889),传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺切除手术分别有2、0和0例次。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组CKD-MBD治疗相关药物月均费用分别为100.2(11.1,322.9)元、361.6(50.1,866.9)元和633.3(121.5,1323.4)元,组间比较差异有统计学意义(P<0.001)。结论新型药物按需治疗模式能明显提高MHD患者MBD生化指标的达标率,减少甲状旁腺切除手术需求,但增加了MBD相关治疗药物的费用。
Objective To analyze the biochemical indicators,clinical events and related drug costs of mineral and bone disorder(MBD)in maintenance hemodialysis(MHD)patients under different drug treatment modes,to explore the optimal treatment and management plan for improving MBD of hemodialysis patients.Methods According to the use of MBD related drugs in the Hemodialysis Center of Beijing Hospital in different periods,patients with MHD in the corresponding time period were included.A total of 151 patients from January 1-31,2017 were selected as the traditional drugs on-demand treatment group,151 patients from January 1-31,2019 were selected as the new drugs limited treatment group,and 153 patients from January 1-31,2020 were selected as the new drugs on-demand treatment group.All patients were followed up for one year,and the biochemical indicators,bone pain,clinical events,and medical expenses of the three groups were compared.Results There were no statistically significant differences in the proportions of gender,age,dialysis age and diabetes in the three groups(P>0.05).There was statistically significant difference in the serum calcium levels in the traditional drugs on-demand treatment group,the new drugs limited treatment group and the new drugs on-demand treatment group[2.30(2.15,2.43)mmol/L,2.20(2.11,2.34)mmol/L and 2.21(2.12,2.30)mmol/L,P<0.001],and the attainment rates of serum calcium were 49.0%,57.6% and 65.4% according to the K/DOQI standard,the difference among the groups was statistically significant(P=0.016).The difference was not statistically significant in blood phosphorus levels[(1.74±0.51)mmol/L,(1.76±0.50)mmol/L and(1.65±0.44)mmol/L,P=0.081],while the attainment rates of serum calcium were45.0%,43.7% and 58.8% according to the K/DOQI standard,and the difference was statistically significant(P=0.014).There was statistically significant difference in the calcium-phosphorus product among the three groups[49.25(40.13,58.46),47.42(38.59,55.95)and 43.44(35.41,52.62),P=0.024].There was no significant difference in the levels of parathyroid hormone(PTH)among the three groups(P=0.465).According to the K/DOQI standard,the PTH attainment rates were24.5%,35.8% and 36.6%,respectively,and according to the KDIGO standard,the PTH attainment rates were 51.0%,60.3% and 66.0%,and the differences among the three groups were statistically significant(P=0.042,P=0.048).There were 109(72.2%),101(66.9%)and 87(56.9%)patients in traditional drugs on-demand treatment group,the new drugs limited treatment group and the new drugs on-demand treatment group using calcium-containing phosphorus binders,and 0(0.0%),76(50.3%)and 87(56.9%)patients using calcium-free phosphorus binders,and 0(0.0%),35(23.2%)and 47(30.7%)of the patients using calcimimetic,the differences were all statistically significant(P<0.05).During the follow-up period,there was no significant difference in the incidence of fractures and cardiovascular and cerebrovascular events among the three groups(P=0.703,P=0.889).There were two,0 and 0 cases of parathyroidectomy(PTX)in traditional drugs on-demand treatment group,the new drugs limited treatment group and the new drugs on-demand treatment group,respectively.The average monthly costs of CKD-MBD treatment-related drugs in traditional drugs on-demand treatment group,the new drugs limited treatment group and the new drugs on-demand treatment group were 100.2(11.1,322.9)yuan,361.6(50.1,866.9)yuan and633.3(121.5,1323.4)yuan,respectively,the difference among the groups was statistically significant(P<0.001).Conclusions The new drug on-demand treatment mode can significantly improve the attainment rate of biochemical indicators of MBD in MHD patients,reduce the demand for PTX,but increases the cost of MBD related treatment.
作者
王松岚
陈爱群
毛永辉
陈献广
孙颖
徐冷楠
Wang Songlan;Chen Aiqun;Mao Yonghui;Chen Xianguang;Sun Ying;Xu Lengnan(Department of Nephrology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《北京医学》
CAS
2021年第12期1151-1157,共7页
Beijing Medical Journal
基金
中国医学科学院项目(BJ-2020-056)
北京医院121工程项目(121-2016008)。
关键词
矿物质和骨代谢异常
高磷血症
治疗模式
血液透析
费用
mineral and bone disorders(MBD)
hyperphosphatemia
treatment mode
hemodialysis
expenditure
