Moe Sharon M, Drüeke Tilman
Department of Medicine, Indiana University School of Medicine, Roudebush VA Medical Center, 1001 W. 10th Street, OPW 526, Indianapolis, IN 46202, USA.
Clin J Am Soc Nephrol. 2008 Nov;3 Suppl 3(Suppl 3):S127-30. doi: 10.2215/CJN.04331206.
Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease and an important cause of morbidity, decreased quality of life, and extraskeletal calcification that have been associated with increased cardiovascular mortality. Kidney Disease: Improving Global Outcomes (KDIGO)'s Global Mineral and Bone Initiative has sought to update the definition, evaluation, and classification of this mineral and bone disorder; improve standardization of assessment tools; enhance education about these complications; and stimulate research. In addition, this international organization sponsored a Controversies Conference in 2005 to define these complications better. The recommendations from that conference were that (1) the term "renal osteodystrophy" be used exclusively to define alterations in bone morphology that are associated with chronic kidney disease and (2) the term "chronic kidney disease-mineral and bone disorder" (CKD-MBD) can be used to describe the broader clinical syndrome that develops as a systemic disorder of mineral and bone metabolism as a result of chronic kidney disease. Chronic kidney disease-related mineral and bone disorders is manifested by an abnormality of any one or a combination of the following: Laboratory (abnormalities of calcium, phosphorus, parathyroid hormone, or vitamin D metabolism), bone (changes in bone turnover, mineralization, volume, linear growth, or strength), and calcification (vascular or other soft tissue calcification). The use of a common, internationally accepted terminology should ease the comparison of studies in this field and eventually improve patient care worldwide.
矿物质和骨代谢紊乱在慢性肾脏病中普遍存在，是发病率增加、生活质量下降以及与心血管死亡率升高相关的骨骼外钙化的重要原因。改善全球肾脏病预后组织（KDIGO）的全球矿物质和骨倡议旨在更新这种矿物质和骨疾病的定义、评估和分类；提高评估工具的标准化；加强对这些并发症的教育；并推动研究。此外，该国际组织在2005年主办了一次争议会议，以更好地界定这些并发症。该会议的建议是：（1）术语“肾性骨营养不良”应专门用于定义与慢性肾脏病相关的骨形态改变；（2）术语“慢性肾脏病-矿物质和骨紊乱”（CKD-MBD）可用于描述作为慢性肾脏病导致的矿物质和骨代谢系统性紊乱而出现的更广泛临床综合征。慢性肾脏病相关的矿物质和骨紊乱表现为以下任何一项或多项的异常：实验室检查（钙、磷、甲状旁腺激素或维生素D代谢异常）、骨骼（骨转换、矿化、体积、线性生长或强度改变）以及钙化（血管或其他软组织钙化）。使用通用的、国际认可的术语应便于该领域研究的比较，并最终改善全球范围内的患者护理。
