从KDOQI到KDIGO指南解读慢性肾脏病矿物质和骨异常

[e-mail]1005－2194201112－0927－03R589．5ACKD。CKD。2004KDOQI。2009KDIGO－CKD-MBD、、。CKD-MBD、3。KDOQIKDIGOChronickidneydisease-mineralandbonedisorderfromKDOQItoKDIGO．CHENZi-jinCHENNan．RuijinHospitalAffiliatedtoShanghaiJiaotongUniversitySchoolofMedicineShanghai200025ChinaSummaryDisturbancesinmineralandbonemetabolismarecommoninpatientswithchronickidneydiseaseCKD．WeusedtofollowKidneyDiseaseOutcomesQualityInitiativeKDOQIestablishedbyNationalKidneyFoundationNKFin2004．In2009KidneyDiseaseImprovingGlobalOutcomesKDIGOpublishedthemineralandbonedisorderofchronickidneydiseaseguidelines．WewillreviewthedifferencesbetweenKDOQIandKDI-GO．KeywordschronickidneydiseaseKDOQIKDIGOcalciumphosphorusparathyroidhormonebonedisease、、。。、《》、《》《》。400SCI406。、、。CKD。CKD。NKF2004KDOQI———BMD1。2009KDIGO———CKD-MBD、、CKD-MBD2。KDOQIKDIGOCKDCKD-MBD、。1CKD-MBDKDIGOCKD-MBD。CKD-MBD、、PTHD、、、。2CKD-MBDCKDCKD3KDIGOKDOQICKD3、PTH13。7292011123112AKPCKD5KDIGOAKP4。25DKDIGOCKD3～525D5。、、PTH25D、、KDIGO。1KQODIKDIGOCaPPTHAKP25OHD3KDOQICKD31212PTHCKDCKD433CKD513KDIGOCKD36～1211CKD43～66～126～12CKD5～5D1～33～66～123CKD-MBD、KDOQIKDIGO、2。2KDOQIKDIGO、KDOQICKD3～40.81～1.45mmol/LCKD51.13～1.78mmol/L2.1～2.37mmol/LCKD5～5D1.13～1.78mmol/L2.1～2.37mmol/LKDIGOCKD3～40.81～1.45mmol/LCKD50.81～1.45mmol/LCKD5～5DKDOQI、KDOQICKD3～5D＜55mg2/dL2。KDIGO、6－7。KDIGO8。DOPPS6。KDIGOCKD3～5D0.81～1.45mmol/L。PTH、。DOPPS2.50mmol/L2.10mmol/LCKD。KDIGO2.1～2.50mmol/L。4CKD-MBDPTHKDOQIKDIGOPTH3。PTHKDIGOCKD3～5PTH、D。KDIGOCKD5DPTHPTH2～9130～600ng/L9。KDIGOCKD5DPTH2～9PTHPTH。3KDOQIKDIGOPTHCKD3CKD4CKD5CKD5DKDOQI3.85～7.7pmol/L7.7～12.1pmol/L16.5～33.0pmol/L16.5～33.0pmol/LKDIGO14.3～66.0pmol/L5CKD-MBDKDIGOKDOQI。KDOQIKDIGOCKD3～5D、、829ChineseJournalofPracticalInternalMedicineDec．2011Vol．31No．12、、CKD-MBD。KDIGOCMVC、MV。TMV、。。CKD3～5DPTH、AKPKDIGOPTHAKP。CKDBMDKDOQIBMD。BMDCKD。CKD3～4BMD85%10。CKD4～5BMDBMDCKD4～5DKDIGOBMD11。6CKD-MBDCKD-MBD。CKD。CTCAC。XCACKDIGOXCT12。CKDKDIGOCKD3～5D。KDIGOCKD-MBD。KDIGO、KDIGO。2003KDOQI。、PTH25D3。1NationalKidneyFoundation．KDOQIClinicalPracticeGuidelinesforBoneMetabolismandDiseaseinChronicKidneyDiseaseJ．AmJKidneyDis200342suppl3S1－S202．2KDIGOClinicalPracticeGuidelinefortheDiagnosisEvaluationPreventionandTreatmentofChronicKidneyDisease-MineralandBoneDisorderCKD-MBDJ．KidneyInternational200976Suppl113S1－S2．3VassalottiJAUribarriJChenSCetal．Trendsinmineralmetabo-lismKidneyEarlyEvaluationProgramKEEPandtheNationalHealthandNutritionExaminationSurveyNHANES1999—2004J．AmJKidneyDis200851S56－S68．4RegidorDLKovesdyCPMehrotraRetal．Serumalkalinephos-phatasepredictsmortalityamongmaintenancehemodialysispa-tientsJ．JAmSocNephrol2008192193－2203．5HollisBW．AssessmentofvitaminDstatusanddefinitionofanor-malcirculatingrangeof25-hydroxyvitaminDJ．CurrOpinEn-docrinolDiabetesObes2008156489－494．6TentoriFBlayneyMJAlbertJMetal．MortalityriskfordialysispatientswithdifferentlevelsofserumcalciumphosphorusandPTHtheDialysisOutcomesandPracticePatternsStudyDOPPSJ．AmJKidneyDis200852519－530．7KettelerMBrandenburgVJahnen-DechentWetal．DonotbemisguidedbyguidelinesthecalciumxphosphateproductcanbeaTrojanhorseJ．NephrolDialTransplant200520673－677．8DhingraRSullivanLMFoxCSetal．Relationsofserumphos-phorusandcalciumlevelstotheincidenceofcardiovasculardis-easeinthecommunityJ．ArchInternMed2007167879－885．9BarretoFCBarretoDVMoysesRMetal．K/DOQI-recommendedintactPTHlevelsdonotpreventlow-turnoverbonediseaseinhe-modialysispatientsJ．KidneyInt200873771－777．10ZhangQLRothenbacherD．Prevalenceofchronickidneydiseaseinpopulation-basedstudiessystematicreviewJ．BMCPublicHealth20088117．11JamalSAHaydenJABeyeneJ．Lowbonemineraldensityandfracturesinlong-termhemodialysispatientsameta-analysisJ．AmJKidneyDis200749674－681．12BellasiAFerramoscaEMuntnerPetal．CorrelationofsimpleimagingtestsandcoronaryarterycalciummeasuredbycomputedtomographyinhemodialysispatientsJ．KidneyInt2006701623－1628．2011－08－142011－09－159292011123112