慢性肾脏病1-5期的矿物质代谢参数——达到K/DOQI目标范围

Mineral metabolism parameters throughout chronic kidney disease stages 1-5--achievement of K/DOQI target ranges.

作者信息

Craver Lourdes, Marco Maria Paz, Martínez Isabel, Rue Montserrat, Borràs Merce, Martín Maria Luisa, Sarró Felipe, Valdivielso José Manuel, Fernández Elvira

机构信息

Hospital Universitari Arnau de Vilanova, Av Rovira Roure, 25198 Lleida, Spain.

出版信息

Nephrol Dial Transplant. 2007 Apr;22(4):1171-6. doi: 10.1093/ndt/gfl718. Epub 2007 Jan 5.

DOI:10.1093/ndt/gfl718

PMID:17205962

Abstract

BACKGROUND

Dialysis Outcomes and Practice Patterns Study has shown that the proportion of haemodialysis patients with adequate mineral metabolism parameters according to the Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines is very low. The adequacy of such parameters in relation to the recommended ranges in patients with different chronic kidney disease (CKD) stages has not been reported. The objective of this study is to provide an in-depth description of mineral metabolism in the early stages of CKD in a European population, and to compare it with current recommendations for stages 3-5 (K/DOQI guidelines).

METHODS

A total of 1836 patients were classified into stages 1-5 according to K/DOQI guidelines. The following clinical and biochemical data were recorded: age, gender, CKD aetiology, presence of diabetes, serum creatinine, creatinine clearance, serum phosphate, calcium, CaxP product and intact parathyroid hormone (PTH).

RESULTS

A decrease in 1,25-dihydroxyvitamin D and an increase in PTH are the earliest mineral metabolism alterations in CKD, while serum calcium and phosphate are altered later in the course of CKD. The percentages of patients with serum levels within the recommended K/DOQI guidelines for stages 3, 4 and 5 were as follows: serum calcium: 90.7, 85.6 and 55; serum phosphate: 90.9, 77.1 and 70.3; iPTH 42.4, 24.6 and 46.8 and Ca x P product 99.9, 99.6 and 83.8, respectively. The percentages of patients who had all four parameters within the recommended ranges were 34.9, 18.4 and 21.6 for stages 3, 4 and 5, respectively.

CONCLUSION

Mineral metabolism disturbances start early in the course of CKD. The first alterations to take place are a 1,25-dihydroxyvitamin D decrease, a 24 h urine phosphate decrease and a PTH elevation, which show significant level variation when the glomerular filtration rate falls below 60 ml/min. K/DOQI recommended levels for mineral metabolism parameters are difficult to accomplish, in particular for PTH levels.

摘要

背景

透析结局与实践模式研究表明，根据肾脏病预后质量倡议（K/DOQI）指南，矿物质代谢参数达标的血液透析患者比例非常低。尚未有关于不同慢性肾脏病（CKD）阶段患者这些参数与推荐范围相比的达标情况的报道。本研究的目的是深入描述欧洲人群CKD早期阶段的矿物质代谢情况，并将其与目前针对3 - 5期的推荐（K/DOQI指南）进行比较。

方法

根据K/DOQI指南，共1836例患者被分为1 - 5期。记录以下临床和生化数据：年龄、性别、CKD病因、糖尿病情况、血清肌酐、肌酐清除率、血清磷酸盐、钙、钙磷乘积及全段甲状旁腺激素（PTH）。

结果

1,25 - 二羟维生素D降低和PTH升高是CKD最早出现的矿物质代谢改变，而血清钙和磷酸盐在CKD病程后期才发生改变。3、4、5期患者血清水平在K/DOQI指南推荐范围内的百分比分别为：血清钙：90.7%、85.6%和55%；血清磷酸盐：90.9%、77.1%和70.3%；iPTH 42.4%、24.6%和46.8%；钙磷乘积99.9%、99.6%和83.8%。3、4、5期所有四项参数均在推荐范围内的患者百分比分别为34.9%、18.4%和21.6%。