Ando Ryoichi
Department of Nephrology, Musashino Red Cross Hospital, Japan.
Clin Calcium. 2014 Dec;24(12):1845-51.
Abnormalities in bone and mineral metabolism begin to develop in the early stage of CKD. Serum phosphorus, calcium, PTH, and alkaline phosphatase are recommended to be measured from CKD stage 3, and it is suggested that these markers are maintained within the reference ranges of each facility. The management of phosphorus is essential and is composed of phosphorus restriction and phosphate binders. Small amount of VDRA suppresses PTH for secondary hyperparathyroidism and is expected to reduce mortality and proteinuria. The effects of the intervention to reduce the phosphorus load before hyperphosphatemia is manifested need to be investigated.
慢性肾脏病（CKD）早期即开始出现骨与矿物质代谢异常。建议从CKD 3期开始检测血清磷、钙、甲状旁腺激素（PTH）和碱性磷酸酶，并建议将这些指标维持在各医疗机构的参考范围内。磷的管理至关重要，包括限制磷摄入和使用磷结合剂。小剂量维生素D受体激动剂（VDRA）可抑制继发性甲状旁腺功能亢进的PTH，有望降低死亡率和蛋白尿。在高磷血症出现之前减轻磷负荷的干预措施的效果有待研究。
