Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
Nephrol Dial Transplant. 2013 Jul;28(7):1922-35. doi: 10.1093/ndt/gfs418. Epub 2012 Nov 19.
Chronic kidney disease-mineral and bone disorders (CKD-MBD) are important complications of CKD5D patients that are associated with mortality.
COSMOS is a multicentre, open cohort, prospective, observational 3-year study carried out in haemodialysis patients from 20 European countries during 2005-07. The present article describes the main characteristics of the European dialysis population, the current practice for the prevention, diagnosis and treatment of secondary hyperparathyroidism and the differences across different European regions.
The haemodialysis population in Europe is an aged population (mean age 64.8±14.2 years) with a high prevalence of diabetes (29.5%) and cardiovascular disease (76.0%), and 28.7% of patients have been on haemodialysis more than 5 years. Patients from the former Eastern countries are younger (59.3±14.3 versus 66.0±13.9), having a lower proportion of diabetics (24.1 versus 30.7%). There were relevant differences in the frequency of measurement of the main CKD-MBD biochemical parameters [Ca, P and parathyroid hormone (PTH)] and the Eastern countries showed a poorer control of these biochemical parameters (K/DOQI and K/DIGO targets). Overall, 48.0% of the haemodialysis patients received active vitamin D treatment. Calcitriol use doubled that of alfacalcidiol in the Mediterranean countries, whereas the opposite was found in the non-Mediterranean countries. The criteria followed to perform parathyroidectomy were different across Europe. In the Mediterranean countries, the level of serum PTH considered to perform parathyroidectomy was higher than in non-Mediterranean countries; as a result, in the latter, more parathyroidectomies were performed in the year previous to inclusion to COSMOS.
The COSMOS baseline results show important differences across Europe in the management of CKD-MBD.
慢性肾脏病-矿物质和骨异常（CKD-MBD）是 CKD5D 患者的重要并发症，与死亡率相关。
COSMOS 是一项多中心、开放队列、前瞻性、观察性的 3 年研究，于 2005-07 年在 20 个欧洲国家的血液透析患者中进行。本文描述了欧洲透析人群的主要特征、目前预防、诊断和治疗继发性甲状旁腺功能亢进症的实践以及不同欧洲地区之间的差异。
欧洲血液透析人群为老年人群（平均年龄 64.8±14.2 岁），糖尿病（29.5%）和心血管疾病（76.0%）患病率较高，28.7%的患者血液透析时间超过 5 年。来自前东欧国家的患者年龄较小（59.3±14.3 岁 vs. 66.0±13.9 岁），糖尿病比例较低（24.1% vs. 30.7%）。主要 CKD-MBD 生化参数[Ca、P 和甲状旁腺激素（PTH）]的测量频率存在显著差异，东欧国家这些生化参数的控制较差（K/DOQI 和 K/DIGO 目标）。总体而言，48.0%的血液透析患者接受活性维生素 D 治疗。钙三醇的使用在地中海国家是阿法骨化醇的两倍，而在非地中海国家则相反。在欧洲，甲状旁腺切除术的手术标准不同。在地中海国家，考虑行甲状旁腺切除术的血清 PTH 水平高于非地中海国家；因此，在后者，更多的甲状旁腺切除术是在纳入 COSMOS 之前的一年进行的。
COSMOS 基线结果显示，欧洲在 CKD-MBD 管理方面存在重要差异。
