Thomsen Stephen
Hudson Essex Nephrology, Union City, N.J., USA.
Case Rep Nephrol Urol. 2013 Jun 11;3(1):74-86. doi: 10.1159/000353265. eCollection 2013.
In addition to hypertension and diabetes, disorders in mineral metabolism and bone disease (e.g. affecting phosphorus, calcium, parathyroid hormone, and vitamin D) are common complications of chronic kidney disease (CKD) and contribute to morbidity and mortality. Consequently, CKD requires multifactorial treatment to slow CKD progression and avoid end-stage renal disease. CKD progression and treatment outcomes are monitored by measuring the estimated glomerular filtration rate (eGFR), which decreases by 2-12 ml/min/1.73 m(2) per year depending on the stage of CKD and comorbidities, such as diabetes. This paper presents representative case studies illustrating the delay and reversal of CKD progression with comprehensive, individualized treatment regimens, including non-calcium phosphate binders, antihypertensives, lipid-lowering drugs, calcimimetics, and other drugs as required, to treat each component of CKD including CKD-mineral and bone disorder. Four patients are included, with an average age of 70-81 years and CKD stage 3 or 4 accompanied by various comorbidities, most notably diabetes and hypertension. The range of treatment and follow-up durations was 6-7 years. In each case, there was evidence of slowing or prevention of CKD progression, according to eGFR and serum creatinine, regardless of the patient's age or CKD stage. Despite a baseline eGFR of <20 ml/min/1.73 m(2) in 1 female patient, after 6 years of follow-up, her eGFR had stabilized and was maintained at >15 ml/min/1.73 m(2). These observations reinforce the value of early nephrology referral and comprehensive management of CKD and underlying conditions (hypertension and diabetes) beginning at eGFR <60 ml/min/1.73 m(2).
除高血压和糖尿病外，矿物质代谢紊乱和骨病（如影响磷、钙、甲状旁腺激素和维生素D）是慢性肾脏病（CKD）的常见并发症，会导致发病和死亡。因此，CKD需要多因素治疗以减缓CKD进展并避免终末期肾病。通过测量估计肾小球滤过率（eGFR）来监测CKD进展和治疗效果，根据CKD阶段和合并症（如糖尿病），eGFR每年下降2 - 12 ml/min/1.73 m²。本文介绍了具有代表性的病例研究，这些研究说明了通过综合、个体化治疗方案（包括非钙磷结合剂、抗高血压药、降脂药、拟钙剂以及根据需要使用的其他药物）来治疗CKD的各个组成部分（包括CKD - 矿物质和骨紊乱），从而延缓和逆转CKD进展。纳入了4例患者，平均年龄为70 - 81岁，CKD为3期或4期，并伴有各种合并症，最显著的是糖尿病和高血压。治疗和随访时间范围为6 - 7年。在每个病例中，根据eGFR和血清肌酐，均有证据表明CKD进展减缓或得到预防，无论患者年龄或CKD阶段如何。尽管1例女性患者的基线eGFR<20 ml/min/1.73 m²，但经过6年随访，她的eGFR已稳定并维持在>15 ml/min/1.73 m²。这些观察结果强化了早期肾病转诊以及从eGFR<60 ml/min/1.73 m²开始对CKD及其基础疾病（高血压和糖尿病）进行综合管理的价值。
