Cozzolino Mario, Galassi Andrea, Pasho Sabina, Fallabrino Guditta, Gallieni Maurizio, Brancaccio Diego
Chair and Division of Nephrology, University of Milan, S. Paolo Hospital, Milan, Italy.
Contrib Nephrol. 2008;161:234-239. doi: 10.1159/000130696.
Abnormalities of bone mineral parameters (calcium, phosphate, vitamin D, and parathyroid hormone) are nearly omnipresent in patients with advanced chronic kidney disease (CKD). These typically consist of hypocalcemia, hyperphosphatemia, abnormalities of vitamin D metabolism, and secondary hyperparathyroidism (SHPT). Currently, several lines of evidence suggest that these abnormalities may have consequences beyond the typical consequence of renal bone disease, with a major role in determining cardiovascular disease, including arterial calcification. The 'classical' treatment of SHPT and hyperphosphatemia in HD patients consists of phosphate binders, vitamin D receptor activators (VDRAs), and/or calcimimetics. Calcium- or aluminum-based phosphate binder prescriptions and calcitriol administration are therapeutic tools not free of complications, increasing the risk of cardiovascular calcification in the HD population. New calcium- and aluminum-free phosphate binders, such as lanthanum carbonate and sevelamer hydrochloride, new VDRA (paricalcitol), and cinacalcet hydrochloride can be used to treat SHPT, slow down the atherosclerotic process, and prevent vascular calcification in HD patients.
晚期慢性肾脏病（CKD）患者几乎普遍存在骨矿物质参数（钙、磷、维生素D和甲状旁腺激素）异常。这些异常通常包括低钙血症、高磷血症、维生素D代谢异常和继发性甲状旁腺功能亢进（SHPT）。目前，有几条证据表明，这些异常可能产生超出肾性骨病典型后果的影响，在决定心血管疾病（包括动脉钙化）方面起主要作用。血液透析（HD）患者SHPT和高磷血症的“经典”治疗包括使用磷结合剂、维生素D受体激活剂（VDRAs）和/或拟钙剂。基于钙或铝的磷结合剂处方以及骨化三醇给药并非没有并发症，会增加HD人群心血管钙化的风险。新型无钙和无铝的磷结合剂，如碳酸镧和盐酸司维拉姆，新型VDRAs（帕立骨化醇）以及盐酸西那卡塞可用于治疗HD患者的SHPT、减缓动脉粥样硬化进程并预防血管钙化。
