Jean Guillaume, Daugas Éric, Roth Hubert, Drueke Tilman, Bouchet Jean-Louis, Hannedouche Thierry, London Gérard, Fouque Denis
NephroCare Tassin-Charcot, 7, avenue du Maréchal-Foch, 69110 Sainte-Foy-lès-Lyon, France.
Service de néphrologie, université Paris-Diderot, Inserm U1149, hôpital Bichat, DHU FIRE, AP-HP, 75877 Paris, France.
Nephrol Ther. 2017 Nov;13(6):470-478. doi: 10.1016/j.nephro.2017.02.009. Epub 2017 Aug 23.
Only limited data is available on the management of the chronic kidney disease-associated bone and mineral metabolism disorder (CKD-MBD) in the pre-dialysis stages of CKD in France. A better knowledge of current management habits could lead to an improvement in the implementation of international recommendations (KDIGO). The 3rd version of the French Phosphorus and Calcium Survey Photo-Graphe (Sanofi) included a cohort of CKD stages 4 and 5 patients, whose aim was to examine the prevalence of CKD-MBD and the quality of its management in patients under the care of 62 nephrologists from over 20 geographical regions in France. The study started in October 2011, i.e. one year after patient enrollment. We examined in particular the percentage of patients presenting with laboratory parameter abnormalities indicative of CKD-MBD who were not receiving adequate treatment. A total of 456 patients with CKD stage 4 and 154 with CKD stage 5 were studied. Their mean age was 72.9±14.2 years, and male/female ratio was 58/42. KDIGO targets of serum PTH for CKD stages 4 and 5 were not achieved in respectively 80 and 84% of the patients, for serum calcium in 8 and 22% and for serum phosphate in 12 and 46%. As a potential explanation, insufficient therapy was estimated to account for respectively 45 and 60% of insufficiently controlled secondary hyperparathyroidism, and for 36% of persistent hyperphosphatemia in stage 5. It should be noted that 55.5 and 57.5% of patients were receiving native vitamin D. In this national observatory, the management of CKD-MBD stages 4 and 5 appears suboptimal, especially as regards the control of secondary hyperparathyroidism, which remained untreated in nearly 50% of the patients. Hyperphosphatemia was also common and inadequately controlled in CKD stage 5. To improve the management of CKD-MBD, nephrologists need to be more aware of the importance of aiming for recommended laboratory targets and how this can be achieved.
在法国，关于慢性肾脏病（CKD）透析前阶段慢性肾脏病相关骨与矿物质代谢紊乱（CKD-MBD）的管理，仅有有限的数据。更好地了解当前的管理习惯可能会促进国际指南（KDIGO）的实施。法国磷与钙调查（赛诺菲）第3版纳入了一组CKD 4期和5期患者，目的是调查CKD-MBD的患病率及其在法国20多个地理区域62位肾脏病专家照料下患者的管理质量。该研究于2011年10月开始，即患者入组一年后。我们特别研究了出现提示CKD-MBD的实验室参数异常但未接受充分治疗的患者百分比。共研究了456例CKD 4期患者和154例CKD 5期患者。他们的平均年龄为72.9±14.2岁，男女比例为58/42。CKD 4期和5期患者的血清甲状旁腺激素（PTH）KDIGO目标分别在80%和84%的患者中未实现，血清钙目标在8%和22%的患者中未实现，血清磷目标在12%和46%的患者中未实现。作为一种可能的解释，估计治疗不足分别占继发性甲状旁腺功能亢进控制不佳的45%和60%，以及5期持续性高磷血症的36%。应注意的是，55.5%和57.5%的患者正在接受天然维生素D治疗。在这个全国性观察研究中，CKD 4期和5期的CKD-MBD管理似乎并不理想，尤其是在继发性甲状旁腺功能亢进的控制方面，近50%的患者仍未得到治疗。高磷血症在CKD 5期也很常见且控制不佳。为改善CKD-MBD的管理，肾脏病专家需要更加意识到实现推荐的实验室指标目标的重要性以及如何实现这一目标。
