关键词: 维持性血液透析, 高磷血症, 磷结合剂, 继发性甲状旁腺功能亢进

Abstract: Objective: To investigate clinical characteristics and factors associated with serum phosphorus in MHD patients with uncontrolled phosphorus. Methods: 464 MHD patients from 10 dialysis centers of Peking University People’s Hospital Hemodialysis Consortium (Q3 2023) were enrolled. Primary disease, dialysis adequacy, serum phosphorus, corrected calcium, PTH, and phosphate binder use were collected; daily phosphate⁃binding capacity was calculated. Spearman correlation and multivariate linear regression were applied. Results: Of 464 patients, 287 (61.85%) were male, mean age 57.48± 13.26 years. Chronic glomerulonephritis (36.00%) and diabetic kidney disease (30.82%) predominated. Achievement rates: 72.21% for dialysis adequacy, 53.20% for corrected calcium, 30.50% for PTH. 11.20% used no binder. The median daily phosphate⁃binding capacity was 105.10 mg/d. Spearman correlation showed extremely small effect sizes with spKt/V (r=-0.093) and PTH (r=0.102) (both P<0.05). PTH>600 pg/mL group had higher binding capacity but still higher phosphorus than PTH≤600 pg/mL group (2.26 vs 2.09 mmol/L, P=0.001). Multivariate regression showed phosphorus independently negatively associated with age (β =-0.004) and spKt/V (β =-0.147), positively with PTH (β=0.049) and non⁃use of vitamin D analogs (β=0.113) (all P<0.05). Conclusion: Insufficient binder dosage, severe SHPT, and inadequate dialysis are correctable factors for uncontrolled phosphorus in MHD patients, warranting timely adjustment of treatment.