Lezaic V, Tirmenstajn-Jankovic B, Bukvic D, Vujisic B, Perovic M, Novakovic N, Dopsaj V, Maric I, Djukanovic Lj
Department of Nephrology, Clinical Center Beograd, Lazarevac, Serbia.
Clin Nephrol. 2009 Jan;71(1):21-9. doi: 10.5414/cnp71021.
Chronic kidney disease mineral- and bone disorder (CKD-MBD) has been studied more often in dialysis than in predialysis CKD patients. The association between efficacy of hyperphosphatemia control and chronic renal failure (CRF) progression, prevalence of bone disease and cardiovascular calcification was the objective of the present investigation.
42 patients with CKD in Stage 5, regularly monitored for 5 years, were divided into Group 1 of 20 patients with normal serum phosphate (sPO4) levels and Group 2 of 22 patients with hyperphosphatemia registered at the majority of checks. Serum urea, creatinine, calcium (sCa) and sPO4 levels were regularly determined in the retrospective 5-year period. At the end of this period iPTH, bone alkaline phosphatase-BAP and inflammation markers (CRP, fetuin-A) were measured, valvular and arterial calcifications were detected by B mode echocardiogram and soft-tissue native radiograms of the pelvis and the wrist.
Progression of CRF (1/sCr over time) was faster in Group 2 than in Group 1 (b = -0.0577 vs. -0.0288, p = 0.003) during the study period. Average BAP and iPTH values were similar in both groups and 23/42 patients had PTH > 300 pg/ml. Arterial and valvular calcifications were found in 5/23 patients from Group 1 and 14/22 patients from Group 2 (p = 0.011). Linear regression analysis revealed sPO4 as a predictor for total calcification number, inflammatory diseases as a predictor for valvular calcifications, while sPO4 and iPTH were predictors for arterial calcifications.
More than half the patients with Stage 5 CKD not yet on dialysis exhibited elevated PTH. Faster CRF progression and frequent arterial and valvular calcifications were seen in patients with poor phosphate control and sPO4 was selected as an independent predictor of total calcification score.
慢性肾脏病矿物质和骨异常（CKD-MBD）在透析患者中的研究比在未透析的CKD患者中更为常见。本研究旨在探讨高磷血症控制效果与慢性肾衰竭（CRF）进展、骨病患病率及心血管钙化之间的关联。
42例5期CKD患者，进行了为期5年的定期监测，分为两组，第1组20例患者血清磷（sPO4）水平正常，第2组22例患者在大多数检查中均有高磷血症。在回顾性的5年期间定期测定血清尿素、肌酐、钙（sCa）和sPO4水平。在此期间结束时，测量了iPTH、骨碱性磷酸酶-BAP和炎症标志物（CRP、胎球蛋白-A），通过B型超声心动图以及骨盆和腕部的软组织X线平片检测瓣膜和动脉钙化情况。
在研究期间，第2组CRF的进展（1/sCr随时间变化）比第1组更快（b = -0.0577对-0.0288，p = 0.003）。两组的平均BAP和iPTH值相似，42例患者中有23例PTH>300 pg/ml。第1组23例患者中有5例出现动脉和瓣膜钙化，第2组22例患者中有14例出现（p = 0.011）。线性回归分析显示，sPO4是总钙化数的预测指标，炎症性疾病是瓣膜钙化的预测指标，而sPO4和iPTH是动脉钙化的预测指标。
超过一半尚未接受透析的5期CKD患者PTH升高。在磷酸盐控制不佳的患者中，CRF进展更快，动脉和瓣膜钙化频繁，sPO4被选为总钙化评分的独立预测指标。
