在21世纪初，我们是否成功治疗了慢性肾病儿童的贫血和钙磷紊乱？

[Do we successfully treat anemia and calcium-phosphate disorders in children with chronic kidney disease at the beginning of the twenty-first century?].

作者信息

Drożdż Dorota, Kwinta Przemko, Sztefko Krystyna, Zachwieja Katarzyna, Miklaszewska Monika, Drożdż Tomasz, Łatka Monika, Pietrzyk Jacek A

出版信息

Przegl Lek. 2015;72(7):349-53.

PMID:26817347

Abstract

UNLABELLED

In children with chronic kidney disease (CKD) anemia and calcium-phosphate disturbances are already present at early stages of the disease and require a comprehensive treatment. The aim of this study was to evaluate the efficacy of the treatment of biochemical disturbances, depending on the severity of CKD in children.

MATERIAL AND METHODS

The study included 71 children (44 boys, 27 girls) with CKD stage 1-5. Mean age was 11 ± 5 years, mean height: 135.7 ± 28 cm and mean eGFR 32 ml/min/1.73 m2. The serum hemoglobin, urea, creatinine, cystatin C, calcium, phosphorus and parathyroid hormone (PTH) levels were measured. eGFR was calculated according to Schwartz and Filler formulas, employing creatinine and cystatin C as markers. Patients were divided into groups depending on the stage of CKD [group 1: CKD stage 1+2 (GFR > 60), group 2: CKD stage 3 (GFR = 30-59) Group 3: CKD stage 4 (GFR = 15-29 ml/min/1.73 m2), group 4 - dialyzed children].

RESULTS

The concentration of he- moglobin depending on the stage of CKD (group 1 vs. group 2 vs. group 3 vs group 4) was 12.95 vs. 12.68 vs. 12.47 vs. 11.3 g/dI, respectively. The concentration of total and ionized calcium was significantly lower in children on dialysis compared to patients treated conservatively. With the progression of CKD the concentration of phosphorus (1.39 vs. 1.4 vs. 1.49 vs. 1.82 mmolI) and PTH (21.7 vs 48.6 vs 99.9 vs. 219 pg/ml) significantly increased. Treatment with erythropoietin was used in 48% of children, calcium carbonate in 55% and alphacalcidol in 56% of patients.

CONCLUSIONS

Despite the use of regular treatment, with the progression of CKD a progression of anemia, increased serum phosphate and parathyroid hormone and a decrease in calcium levels in studied children was observed. The severity of metabolic disorders in dialyzed children indicates the need for administration of new and more effective drugs, to prevent early enough complications of CKD in the form of mineral bone disease and cardiovascular complications.

摘要

未标注

在患有慢性肾脏病（CKD）的儿童中，贫血和钙磷紊乱在疾病早期就已出现，需要综合治疗。本研究的目的是评估根据儿童CKD严重程度进行生化紊乱治疗的疗效。

材料与方法

该研究纳入了71例1 - 5期CKD儿童（44例男孩，27例女孩）。平均年龄为11±5岁，平均身高：135.7±28 cm，平均估算肾小球滤过率（eGFR）为32 ml/min/1.73 m²。测量了血清血红蛋白、尿素、肌酐、胱抑素C、钙、磷和甲状旁腺激素（PTH）水平。根据Schwartz和Filler公式，以肌酐和胱抑素C作为标志物计算eGFR。患者根据CKD分期分为几组[第1组：CKD 1 + 2期（肾小球滤过率>60），第2组：CKD 3期（肾小球滤过率 = 30 - 59），第3组：CKD 4期（肾小球滤过率 = 15 - 29 ml/min/1.73 m²），第4组 - 透析儿童]。

结果

根据CKD分期（第1组 vs. 第2组 vs. 第3组 vs. 第4组），血红蛋白浓度分别为12.95、12.68、12.47和11.3 g/dl。与保守治疗的患者相比，透析儿童的总钙和离子钙浓度显著降低。随着CKD的进展，磷浓度（1.39 vs. 1.4 vs. 1.49 vs. 1.82 mmol/L）和PTH（21.7 vs 48.6 vs 99.9 vs. 219 pg/ml）显著升高。48%的儿童使用促红细胞生成素治疗，55%使用碳酸钙，56%使用阿法骨化醇。