Wazny Lori D, Raymond Colette B, Lesperance Esther M, Bernstein Keevin N
Department of Pharmaceutical Services, Health Sciences Centre, Winnipeg, MB.
CANNT J. 2008 Apr-Jun;18(2):36-41, 44-50; quiz 42-3, 51-2.
The calcium, phosphorus, and parathyroid hormone targets recommended by the Canadian Society of Nephrology (CSN) encompass a wider range of values as compared to the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines. We sought to compare mineral metabolism parameters within the Manitoba Renal Program (MRP) to the CSN and NKF-K/DOQI guidelines. Medication use was also examined.
All hemodialysis patients in Manitoba were evaluated. Values for serum albumin, phosphorus, calcium, intact parathyroid hormone (PTH) and pertinent medications were collected.
Five hundred and forty-six patients were included in the analysis. Fifty-three per cent to 81% of MRP patients met individual CSN targets. However, only 26% of patients achieved all targets, despite high usage of phosphate (85.5% calcium carbonate, 16.1% sevelamer, 1.3% aluminum) and PTH-lowering drug therapies (30.2% calcitriol, 2.7% cinacalcet).
Only a small proportion of patients were able to achieve all three CSN mineral metabolism targets simultaneously. The majority of outliers presented with hyperphosphatemia or hypoparathyroidism.
与美国国家肾脏基金会的《肾脏病预后质量倡议》（NKF-K/DOQI）指南相比，加拿大肾脏病学会（CSN）推荐的钙、磷和甲状旁腺激素目标涵盖了更广泛的值范围。我们试图将曼尼托巴肾脏项目（MRP）中的矿物质代谢参数与CSN和NKF-K/DOQI指南进行比较。还对药物使用情况进行了检查。
对曼尼托巴省所有血液透析患者进行评估。收集血清白蛋白、磷、钙、完整甲状旁腺激素（PTH）的值以及相关药物。
546名患者纳入分析。53%至81%的MRP患者达到了CSN的各项个体目标。然而，尽管磷酸盐（85.5%碳酸钙、16.1%司维拉姆、1.3%铝）和降低PTH的药物疗法（30.2%骨化三醇、2.7%西那卡塞）使用率很高，但只有26%的患者实现了所有目标。
只有一小部分患者能够同时达到CSN的所有三项矿物质代谢目标。大多数异常情况表现为高磷血症或甲状旁腺功能减退。
