目的了解单透析中心的维持性血液透析患者慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的发病率及控制情况。方法透析中心的126例维持性血液透析患者透析前空腹取血,检测血钙、血磷、血全段...目的了解单透析中心的维持性血液透析患者慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的发病率及控制情况。方法透析中心的126例维持性血液透析患者透析前空腹取血,检测血钙、血磷、血全段甲状旁腺激素(intact parathyroid hormone,i PTH)水平,并分析三者达标现状,与2014年上海市70家血液透析中心的平均水平比较;采用侧位腹平片了解腹主动脉钙化情况,评估血管钙化发生率;采用跟骨骨密度的超声,了解CKD-MBD伴低骨密度发生率。结果本透析中心126例患者中,符合CKD-MBD诊断标准的患者有116例,占92.0%;126例患者的血磷(2.3±3.71)mmol/L,血钙(2.23士0.33)mmol/L,i PTH(401±421)pg/ml;与2014年上海市70家透析中心的平均水平相比,本中心血钙达标率低于平均水平(35.71%比48.86%,χ2=4.188,P=0.042),血磷达标率低于平均水平(41.85%比61.36%,χ2=21.094,P<0.001);i PTH达标率明显高于平均水平(58.73%比44.91%,χ2=9.581,P<0.001);腹主动脉钙化发生率74.6%;CKD-MBD伴低骨密度发生率72.22%。结论维持性血液透析患者矿物质骨异常的发生率高,CKD-MBD伴低骨密度、血管钙化的问题严重,血钙、磷的达标率低,维持性血液透析患者人群中CKD-MBD的现状值得关注。展开更多
目的探讨碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease mineral and bone disorder,CKD-MBD)患者钙磷代谢的影响,为CKD-MBD患者选择最佳治疗方案,改善患者的生存质量。方法选择陕西省人民医院201...目的探讨碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease mineral and bone disorder,CKD-MBD)患者钙磷代谢的影响,为CKD-MBD患者选择最佳治疗方案,改善患者的生存质量。方法选择陕西省人民医院2014年1月至2015年5月行维持性血液透析的CKD-MBD患者76例,给予口服碳酸镧并按透析方式分为3组,血液透析(hemodialysis,HD)组24例、血液透析联合血液透析滤过(HD and hemodialysis filtration,HD+HDF)组27例,血液透析联合血液灌流(HD and blood perfusion,HD+HP)组25例,比较各组治疗前和治疗3个月后血钙、血磷、钙磷乘积及甲状旁腺素(parathyroid hormone,PTH)的变化。观察3组治疗中不良反应的发生率并进行比较。结果治疗3个月后,3组血钙较治疗前均升高,3组间血钙变化无统计学差异(P>0.05);3组血磷及钙磷乘积较治疗前明显下降(P<0.05),但HD+HDF组、HD+HP组较HD组下降更为明显(P<0.05)。HD组门H在治疗前、后变化不大(P>0.05),HD+HDF组和HD+HP组治疗3个月后PTH较前明显下降(P<0.05)。HD组、HD+HDF组及HD+HP组患者并发症发生率分别为75.0%、18.5%、32.0%,HD组并发症明显高于HD+HDF组和HD+HP组,差异有统计学意义(P<0.05),HD+HDF组并发症发生率最低。结论碳酸镧联合不同血液净化方式对血钙、血磷及PTH的清除效果不同,联合HDF和HP方式能明显清除血磷、PTH,改善钙磷代谢紊乱,不良反应小,适合临床应用治疗CKD-MBD。展开更多
Background：Mineral and bone disorder （MBD）,especially hyperphosphatemia,is an independently risk factor for adverse prognosis in patients with chronic kidney disease （CKD）.However,CKD-MBD among Chinese population...Background：Mineral and bone disorder （MBD）,especially hyperphosphatemia,is an independently risk factor for adverse prognosis in patients with chronic kidney disease （CKD）.However,CKD-MBD among Chinese population was poorly studied.This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.Methods：Chinese Cohort Study of Chronic Kidney Disease （C-STRIDE） is a prospective multicenter cohort study involving predialysis CKD patients in China.Markers of MBD,including serum phosphorus,calcium,and intact parathyroid hormone,were measured in baseline samples at the patients＆#39; entry.The association between serum phosphorus and abdominal aortic calcification （AAC）,left ventricular hypertrophy （LVH） were examined by logistic regression models.Results：Altogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml·min^- 1· 1.73 m^- 2 were included.The proportion of patients with hyperphosphatemia were 2.6%,2.9%,6.8%,and 27.1% in CKD Stages 3a,3b,4,and 5,respectively.Moreover,71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder （PB）.Lateral abdominal X-rays were obtained in 2280 patients,9.8% of the patients were diagnosed as having AAC.Altogether 2219 patients had data of echocardiography,and 13.2% of them were diagnosed with LVH.Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.Conclusions：In Chinese patients with CKD,the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal.The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.展开更多
2009年改善全球肾脏病预后组织(kidney disease:improving global outcomes,KDIGO)发布了关于慢性肾脏病矿物质及骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的诊断、评估、预防和治疗的临床实践指南,为广大临...2009年改善全球肾脏病预后组织(kidney disease:improving global outcomes,KDIGO)发布了关于慢性肾脏病矿物质及骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的诊断、评估、预防和治疗的临床实践指南,为广大临床工作者对CKD-MBD的认识及诊疗提供了详细的指导意见。但指南缺少针对临床终点事件的随机对照研究(randomized control trial,RCT)证据,故其证据质量不高。随着此后多项RCT研究和前瞻性队列研究结果的公布,KDIGO工作组经过对相关新证据的评估和充分讨论,于2017年6月对该指南进行了选择性更新,主要涉及CKD-MBD中骨病的诊断及钙、磷和甲状旁腺素的管理等。本文就主要的更新内容进行解读,揭示其临床意义。展开更多
目的:分析维持性血液透析患者血清钙、磷及成纤维细胞生长因子23(fibroblast growth factor,FGF23)、Klotho蛋白水平,探讨慢性肾病矿物质及骨代谢异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)患者血清FGF23、Kloth...目的:分析维持性血液透析患者血清钙、磷及成纤维细胞生长因子23(fibroblast growth factor,FGF23)、Klotho蛋白水平,探讨慢性肾病矿物质及骨代谢异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)患者血清FGF23、Klotho蛋白水平变化与心血管系统并发症的关系。方法:回顾性分析中南大学湘雅医院CKD-MBD未透析患者(NHD组)、CKD-MBD规律血液透析患者(HD组)及CKD-MBD伴继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)伴腺瘤样增生患者(SHPT组)各60例的MBD及心脏损伤发病情况,比较血液透析对患者病情的影响。同期收集体检中心体检健康的30例对象为对照组,记录其基本情况、收集钙、磷、全段甲状旁腺素(i PTH)等钙磷代谢指标及心脏彩超检查结果。通过酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测各组血清FGF23和Klotho蛋白情况,比较各组之间钙磷代谢相关生化指标、左室肥厚、左室扩大及心脏瓣膜异位钙化之间差异,分析上述指标间相关性,明确CKD-MBD患者心血管损伤的相关因素及其与FGF23蛋白和Klotho蛋白水平的关系。结果:维持性血液透析患者尤其是伴有SHPT的血液透析患者血清FGF23水平明显升高,而血清Klotho蛋白水平明显降低(P<0.01)。FGF23蛋白水平降低者发生异位钙化风险升高(OR=4.667);Klotho蛋白水平降低者发生心肌肥厚风险升高(OR=3.496)。在慢性肾病患者异位钙化诊断中的血清FGF23蛋白水平ROC曲线下面积为0.778(P<0.01);血清Klotho蛋白水平ROC曲线下面积为0.715(P<0.01)。结论:血清FGF23增多、Klotho蛋白减少是CKD心脏损伤的危险因素。FGF23和Klotho蛋白可作为诊断和预测CKD-MBD患者心脏异位钙化的临床指标。展开更多
慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)是(chronic kidney disease,CKD)进展过程中常见的并发症,与CKD患者住院率增加、生活质量下降、心血管钙化和心血管死亡率及全因死亡率增高密切相...慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)是(chronic kidney disease,CKD)进展过程中常见的并发症,与CKD患者住院率增加、生活质量下降、心血管钙化和心血管死亡率及全因死亡率增高密切相关,明确CKD-MBD相关的血钙、血磷及甲状旁腺激素(parathyroid hormone,PTH)等指标的控制靶目标范围是临床工作者关注的焦点,国内外亦已提出相应指南或共识建议。总体而言,各指南或共识对血磷和血钙的靶目标值基本一致,即尽可能达到和维持在正常参考值范围,钙磷乘积主要受血磷水平的影响,意义相对较小,但对PTH的靶目标值有较大范围波动,特别是KDIGO指南提出将全段甲状旁腺激素(intact parathyroid hormone,i PTH)控制于正常参考值上限约2~9倍引发了关注和争议,然目前已发表的研究结果尚不能给定较为狭窄的范围。在临床实践中CKD-MBD相关指标的动态变化趋势远比孤立的单次数值更有判断价值和指导意义。展开更多
慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease-mineral and bone disorder,CKDMBD)是慢性肾脏病(chronic kidney disease,CKD)患者主要的并发症之一,目前CKD-MBD治疗手段主要包括:磷结合剂、活性维生素D及其类似物、拟钙剂等...慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease-mineral and bone disorder,CKDMBD)是慢性肾脏病(chronic kidney disease,CKD)患者主要的并发症之一,目前CKD-MBD治疗手段主要包括:磷结合剂、活性维生素D及其类似物、拟钙剂等药物治疗以及甲状旁腺手术治疗。其中,活性维生素D及其类似物是最为常见的治疗药物,可以降低甲状旁腺激素(parathyroid hormone,PTH),改善骨质疏松和高转运骨病的骨损害,在临床上应用广泛,但使用不当也会导致高钙、高磷血症及加重血管钙化发展,为了更合理的使用该类药物,本文结合2017年KDIGO的CKD-MBD指南更新并就活性维生素D及其类似物在CKD-MBD的治疗进展进行介绍。展开更多
活性维生素D在临床上应用广泛。对于肝、肾功能逐渐衰退,伴有肌少症和/或神经功能损害的老年骨质疏松症(osteoporosis,OP)患者,妊娠/哺乳相关的OP及骨密度(bone mineral density,BMD)下降患者,均可适当补充。活性维生素D联合钙剂是甲状...活性维生素D在临床上应用广泛。对于肝、肾功能逐渐衰退,伴有肌少症和/或神经功能损害的老年骨质疏松症(osteoporosis,OP)患者,妊娠/哺乳相关的OP及骨密度(bone mineral density,BMD)下降患者,均可适当补充。活性维生素D联合钙剂是甲状旁腺功能减退症和骨软化症的首选治疗方案,同时也是慢性肾脏病-矿物质和骨异常患者预防和治疗继发性甲状旁腺功能亢进症的主要措施之一。活性维生素D治疗窗相对狭窄,用药期间需要定期监测安全性指标,如血钙磷、尿钙磷及全段甲状旁腺素等。展开更多
文摘目的探讨碳酸镧联合不同血液净化方式对慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease mineral and bone disorder,CKD-MBD)患者钙磷代谢的影响,为CKD-MBD患者选择最佳治疗方案,改善患者的生存质量。方法选择陕西省人民医院2014年1月至2015年5月行维持性血液透析的CKD-MBD患者76例,给予口服碳酸镧并按透析方式分为3组,血液透析(hemodialysis,HD)组24例、血液透析联合血液透析滤过(HD and hemodialysis filtration,HD+HDF)组27例,血液透析联合血液灌流(HD and blood perfusion,HD+HP)组25例,比较各组治疗前和治疗3个月后血钙、血磷、钙磷乘积及甲状旁腺素(parathyroid hormone,PTH)的变化。观察3组治疗中不良反应的发生率并进行比较。结果治疗3个月后,3组血钙较治疗前均升高,3组间血钙变化无统计学差异(P>0.05);3组血磷及钙磷乘积较治疗前明显下降(P<0.05),但HD+HDF组、HD+HP组较HD组下降更为明显(P<0.05)。HD组门H在治疗前、后变化不大(P>0.05),HD+HDF组和HD+HP组治疗3个月后PTH较前明显下降(P<0.05)。HD组、HD+HDF组及HD+HP组患者并发症发生率分别为75.0%、18.5%、32.0%,HD组并发症明显高于HD+HDF组和HD+HP组,差异有统计学意义(P<0.05),HD+HDF组并发症发生率最低。结论碳酸镧联合不同血液净化方式对血钙、血磷及PTH的清除效果不同,联合HDF和HP方式能明显清除血磷、PTH,改善钙磷代谢紊乱,不良反应小,适合临床应用治疗CKD-MBD。
文摘Background：Mineral and bone disorder （MBD）,especially hyperphosphatemia,is an independently risk factor for adverse prognosis in patients with chronic kidney disease （CKD）.However,CKD-MBD among Chinese population was poorly studied.This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.Methods：Chinese Cohort Study of Chronic Kidney Disease （C-STRIDE） is a prospective multicenter cohort study involving predialysis CKD patients in China.Markers of MBD,including serum phosphorus,calcium,and intact parathyroid hormone,were measured in baseline samples at the patients＆#39; entry.The association between serum phosphorus and abdominal aortic calcification （AAC）,left ventricular hypertrophy （LVH） were examined by logistic regression models.Results：Altogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml·min^- 1· 1.73 m^- 2 were included.The proportion of patients with hyperphosphatemia were 2.6%,2.9%,6.8%,and 27.1% in CKD Stages 3a,3b,4,and 5,respectively.Moreover,71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder （PB）.Lateral abdominal X-rays were obtained in 2280 patients,9.8% of the patients were diagnosed as having AAC.Altogether 2219 patients had data of echocardiography,and 13.2% of them were diagnosed with LVH.Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.Conclusions：In Chinese patients with CKD,the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal.The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.
文摘2009年改善全球肾脏病预后组织(kidney disease:improving global outcomes,KDIGO)发布了关于慢性肾脏病矿物质及骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的诊断、评估、预防和治疗的临床实践指南,为广大临床工作者对CKD-MBD的认识及诊疗提供了详细的指导意见。但指南缺少针对临床终点事件的随机对照研究(randomized control trial,RCT)证据,故其证据质量不高。随着此后多项RCT研究和前瞻性队列研究结果的公布,KDIGO工作组经过对相关新证据的评估和充分讨论,于2017年6月对该指南进行了选择性更新,主要涉及CKD-MBD中骨病的诊断及钙、磷和甲状旁腺素的管理等。本文就主要的更新内容进行解读,揭示其临床意义。
文摘慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease-mineral and bone disorder,CKDMBD)是慢性肾脏病(chronic kidney disease,CKD)患者主要的并发症之一,目前CKD-MBD治疗手段主要包括:磷结合剂、活性维生素D及其类似物、拟钙剂等药物治疗以及甲状旁腺手术治疗。其中,活性维生素D及其类似物是最为常见的治疗药物,可以降低甲状旁腺激素(parathyroid hormone,PTH),改善骨质疏松和高转运骨病的骨损害,在临床上应用广泛,但使用不当也会导致高钙、高磷血症及加重血管钙化发展,为了更合理的使用该类药物,本文结合2017年KDIGO的CKD-MBD指南更新并就活性维生素D及其类似物在CKD-MBD的治疗进展进行介绍。
文摘活性维生素D在临床上应用广泛。对于肝、肾功能逐渐衰退,伴有肌少症和/或神经功能损害的老年骨质疏松症(osteoporosis,OP)患者,妊娠/哺乳相关的OP及骨密度(bone mineral density,BMD)下降患者,均可适当补充。活性维生素D联合钙剂是甲状旁腺功能减退症和骨软化症的首选治疗方案,同时也是慢性肾脏病-矿物质和骨异常患者预防和治疗继发性甲状旁腺功能亢进症的主要措施之一。活性维生素D治疗窗相对狭窄,用药期间需要定期监测安全性指标,如血钙磷、尿钙磷及全段甲状旁腺素等。
