巴伦西亚社区血液透析患者磷和钙代谢的评估及其临床管理
Assessment of phosphorus and calcium metabolism and its clinical management in hemodialysis patients in the community of Valencia.
作者信息
Maduell Francisco, Gorriz Jose L, Pallardo Luis M, Pons Ramon, Santiago Carlos
机构信息
Department of Nephrology, Castellón General Hospital - Spain.
出版信息
J Nephrol. 2005 Nov-Dec;18(6):739-48.
AIM
The objective of the study was to determine the situation concerning mineral metabolism and bone disease in hemodialysis (HD) patients living in the community of Valencia (Spain), as well as the clinical practices for bone disease control in relation to the laboratory targets recommended in the National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) guidelines.
METHODS
In December 2003, a cross-sectional study was performed including 2392 patients (1485 males and 907 females) from 43 different centers in the council of Valencia (the entire HD population). Mean age was 65.8 +/- 14 yrs. Cut-off levels for the study of calcium, phosphorus, calcium-phosphorus product (Ca x P) and parathyroid hormone (PTH) were performed following the recommendations of the K/DOQI guidelines.
RESULTS
The mean values for calcium were 9.57 +/- 0.7 mg/dL, phosphorus 4.97 +/- 1.5 mg/dL, intact PTH (iPTH) 297 +/- 353 pg/mL, Ca x P 47.5 +/- 15 mg2/dL2. Hypocalcemia (<8.4 mg/dL) was present in 5% of patients, whereas 17.8% of patients presented hypercalcemia (>10.2 mg/dL), 60.3% of whom received vitamin D. Hypophosphoremia (<3.5 mg/dL) was present in 16% of patients, and 29% of patients presented hyperphosphoremia (>5.5 mg/dL). Ca x P was <55 mg2/dL2 in 73% of patients. Thirty one percent of patients presented secondary hyperparathyroidism (HPTH >300 pg/mL), being severe in 12% (>600 pg/mL); 43% of patients presented iPTH <150 pg/mL. Only 7.3% of patients achieved the four recommendations provided in the K/DOQI guidelines. Vitamin D treatment was administered in 48% of patients.
CONCLUSIONS
The population undergoing dialysis in the community of Valencia achieved targets based on the clinical recommendations of the K/DOQI guidelines as follows: 45% of patients achieved targets for calcium, 55% for phosphorus, 73% for Ca x P and 26% for iPTH levels. Surprisingly, only 7.3% of patients achieved all four targets.
目的
本研究的目的是确定居住在西班牙巴伦西亚社区的血液透析（HD）患者的矿物质代谢和骨病情况，以及与美国国家肾脏基金会透析预后质量倡议（K/DOQI）指南中推荐的实验室指标相关的骨病控制临床实践。
方法
2003年12月，进行了一项横断面研究，纳入了来自巴伦西亚市议会43个不同中心的2392例患者（1485例男性和907例女性）（整个HD人群）。平均年龄为65.8±14岁。按照K/DOQI指南的建议确定钙、磷、钙磷乘积（Ca×P）和甲状旁腺激素（PTH）研究的临界值。
结果
钙的平均值为9.57±0.7mg/dL，磷为4.97±1.5mg/dL，完整PTH（iPTH）为297±353pg/mL，Ca×P为47.5±15mg²/dL²。5%的患者存在低钙血症（<8.4mg/dL），而17.8%的患者存在高钙血症（>10.2mg/dL），其中60.3%接受了维生素D治疗。16%的患者存在低磷血症（<3.5mg/dL），29%的患者存在高磷血症（>5.5mg/dL）。73%的患者Ca×P<55mg²/dL²。31%的患者出现继发性甲状旁腺功能亢进（HPTH>300pg/mL），其中12%为重度（>600pg/mL）；43%的患者iPTH<150pg/mL。只有7.3%的患者达到了K/DOQI指南中的四项建议。48%的患者接受了维生素D治疗。
结论
巴伦西亚社区接受透析的人群根据K/DOQI指南的临床建议达到了以下目标：45%的患者钙水平达标，55%的患者磷水平达标，73%的患者Ca×P达标，26%的患者iPTH水平达标。令人惊讶的是，只有7.3%的患者达到了所有四项指标。
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