Neonatal Hypoxic-Ischemic Encephalopathy Treatment Analysis (Report of 46 Cases)
Article ID: 1008-6633 (2003) 03-0324-01
Analysis of elderly patients with chronic renal insufficiency and abnormal bone metabolism from 1998 to 2002.
Seventeen elderly patients with chronic renal insufficiency undergoing maintenance hemodialysis (MHD) were admitted to our hospital and analyzed for calcium and phosphorus metabolism and bone health. The report follows:
Materials and Methods:
1.1 General Information:
The 17 cases include MHD patients with chronic renal insufficiency, comprising 7 males and 10 females; ages ranging from 60 to 81 years, with an average age of 63 years. Hemodialysis duration ranged from 1 to 4 years, averaging 2.1 years, undergoing bicarbonate dialysis for 4 hours, 2 or 3 times a week, with regular individual heparin anticoagulant. The original incidence included 9 cases of chronic glomerulonephritis, 3 cases of diabetic nephropathy, 3 cases of hypertensive nephropathy, 1 case of chronic pyelonephritis, and 1 case of polycystic kidney disease. No liver, gallbladder disease, or cancer was present.
(Received on December 13, 2002) (Edited by Zhou Jigui)
1.2 Observations:
Serum calcium (Ca), serum phosphorus (P), serum alkaline phosphatase (ALP), albumin (ALB), carbon dioxide combining power (CO2CP), serum urea nitrogen (BUN), serum creatinine (Scr), and serum uric acid (UA) changes were observed in the 17 elderly MHD patients after dialysis lasting 1 to 4 years. Bone pain, muscle weakness, and fractures were also monitored.
Results:
2.1 Dialysis treatment in 17 elderly patients with chronic renal insufficiency undergoing hemodialysis (HD): 11 cases of hypocalcemia, 15 cases of hyperphosphatemia. ALP increased in 6 cases, and serum albumin decreased in 15 cases. HD supplemented calcium and active VitD according to the law. Increased (P 0.05), as shown in Table 1.
Table 1: Laboratory Results in MHD Patients (±)
Note: Before and after MHD, △ P < O. Incidence of pain in 17 elderly patients with chronic renal insufficiency before MHD treatment was 2 out of 17 (0.12).
2.2 Muscle weakness occurred in three cases during MHD treatment and calcium supplementation and active VitD, significantly improving muscle weakness and bone pain. A patient experienced a fall and femoral neck fracture after 4 years of MHD.
Discussion:
In patients with chronic renal failure, calcium and phosphate metabolism and renal osteodystrophy are affected, with the incidence of renal osteodystrophy increasing with the life expectancy of MHD patients [1]. Renal osteodystrophy is characterized by enhanced bone resorption and mineral defects due to reduced production of active VitD, chronic metabolic acidosis, and excess parathyroid hormone production [1].
We observed that MHD treatment, calcium supplementation, and active VitD significantly increased serum calcium (P < 0.05), with three cases of hypocalcemia showing serum calcium nearing 2.1 mmol/L; 15 cases still exhibited hyperphosphatemia, with residual renal function gradually diminishing, necessitating increased protein intake during dialysis treatment. Four cases showed increased ALP, with no significant change in ALP compared to MHD treatment.
Before dialysis, chronic renal failure patients, especially those undergoing long-term dialysis, exhibited increased ALP, indicating ongoing secondary hyperparathyroidism-induced bone disease. After MHD treatment, serum albumin significantly increased (P < 0.05), but nine MHD patients still had low serum protein levels, with serum albumin less than 38g/L. Carbon dioxide combining power in MHD patients did not show significant changes pre- and post-dialysis, indicating chronic metabolic acidosis.
MHD patients lose nutrients due to nutritional intake and dialysis, often resulting in malnutrition, hypoproteinemia, and hypoalbuminemia, which can reduce normal mineralized bone tissue. Metabolic acidosis can lead to bone demineralization and osteoporosis. Additionally, the application of heparin in elderly patients with fewer activities and senile osteoporosis factors can increase renal osteodystrophy [2].
Therefore, elderly MHD patients should receive appropriate calcium supplements and active VitD. It is also necessary to correct hyperphosphatemia and metabolic acidosis, engage in appropriate activities, enhance dietary management and guidance to improve nutritional status, and effectively prevent and treat renal osteodystrophy.