Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2010 Jul;25(7):710-6. doi: 10.1007/s11606-010-1316-y. Epub 2010 Mar 30.
Chronic kidney disease (CKD) affects over 26 million Americans and is frequently complicated early in its course by disordered mineral metabolism and metabolic bone disease. Since CKD-related bone loss is often indistinguishable from osteoporosis by standard bone densitometry, many CKD patients may be inappropriately treated with bisphosphonates rather than CKD-specific therapies.
To determine the prevalence of appropriate evaluation, diagnosis and management of metabolic bone disease among individuals with pre-dialysis CKD.
Retrospective cohort study using electronic medical records of 69,215 ambulatory patients seen in the primary care clinics of an academic medical center.
Prevalence of CKD stages 3-4, frequency of diagnostic testing and treatment of metabolic bone disease.
Based on current diagnostic criteria and consistent with national data, CKD was present in 12% of the population. Bisphosphonates were used in 7.2% of patients, 20% of whom met criteria for CKD. Fewer than half of CKD patients underwent testing for parathyroid hormone (PTH) or 25-hydroxyvitamin D (25D) levels. Among those tested, vitamin D deficiency (25D <30 ng/ml) and secondary hyperparathyroidism (PTH >60 pg/ml) were present in 65% and 55%, respectively. Among patients with CKD, bisphosphonate use was nearly seven times as frequent as therapy with active vitamin D (12% vs. 1.7%, p < 0.0001), a primary treatment for CKD-associated metabolic bone disease.
Disordered mineral metabolism in CKD is common, under-diagnosed and under-treated. As a result, bisphosphonates may be prescribed inappropriately in patients with CKD.
慢性肾脏病（CKD）影响着超过 2600 万的美国人，并且在其早期阶段经常伴有矿物质代谢紊乱和代谢性骨病。由于 CKD 相关的骨丢失通常与骨质疏松症无法通过标准骨密度测量区分，许多 CKD 患者可能会被不适当地用双膦酸盐治疗，而不是采用 CKD 特异性治疗。
确定接受透析前 CKD 患者的代谢性骨病的评估、诊断和治疗是否合理。
这是一项使用学术医疗中心初级保健诊所的电子病历进行的回顾性队列研究，共纳入了 69215 名门诊患者。
CKD 3-4 期的患病率、代谢性骨病的诊断检测和治疗频率。
根据目前的诊断标准，与全国数据一致，该人群中 CKD 的患病率为 12%。有 7.2%的患者使用了双膦酸盐，其中 20%的患者符合 CKD 的诊断标准。不到一半的 CKD 患者接受甲状旁腺激素（PTH）或 25-羟维生素 D（25D）水平检测。在接受检测的患者中，维生素 D 缺乏（25D<30ng/ml）和继发性甲状旁腺功能亢进症（PTH>60pg/ml）的发生率分别为 65%和 55%。在 CKD 患者中，双膦酸盐的使用频率几乎是活性维生素 D（12%对 1.7%，p<0.0001）的七倍，活性维生素 D 是治疗 CKD 相关代谢性骨病的主要药物。
CKD 中的矿物质代谢紊乱很常见，但诊断不足且治疗不足。因此，双膦酸盐可能会被不适当地用于 CKD 患者。
