Shroff Rukshana, Wan Mandy, Nagler Evi V, Bakkaloglu Sevcan, Cozzolino Mario, Bacchetta Justine, Edefonti Alberto, Stefanidis Constantinos J, Vande Walle Johan, Ariceta Gema, Klaus Günter, Haffner Dieter, Schmitt Claus Peter
Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Ghent University Hospital, Ghent, Belgium.
Nephrol Dial Transplant. 2017 Jul 1;32(7):1114-1127. doi: 10.1093/ndt/gfx080.
In patients with chronic kidney disease (CKD), renal synthesis of active vitamin D [1,25-dihydroxyvitamin D (1,25(OH)2D)] declines and is associated with hypocalcaemia, secondary hyperparathyroidism and the spectrum of CKD-mineral and bone disorder (MBD). In advanced CKD, active vitamin D analogues, including alfacalcidol, calcitriol and paricalcitol, are routinely administered. There are few studies on the use of vitamin D analogues in children with CKD and on dialysis. It is difficult to define bone-specific outcomes that can guide treatment with active vitamin D analogues in children with CKD-MBD. A core working group (WG) of the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis WGs has developed recommendations for the use of active vitamin D therapy in children with CKD and on dialysis. A second document in parallel with this one covers treatment recommendations for native vitamin D therapy. The WGs have performed an extensive literature review to include systematic reviews and randomized controlled trials in adults and children with CKD and prospective observational studies in children with CKD. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to develop and grade the recommendations. In the absence of applicable study data, the opinion of experts from the ESPN CKD-MBD and Dialysis WGs is provided, but clearly GRADE-ed as such and must be carefully considered by the treating physician and adapted to individual patient needs as appropriate.
在慢性肾脏病（CKD）患者中，肾脏活性维生素D[1,25-二羟维生素D（1,25(OH)₂D）]的合成减少，并与低钙血症、继发性甲状旁腺功能亢进以及CKD-矿物质和骨 disorder（MBD）相关。在晚期CKD中，通常会使用活性维生素D类似物，包括阿法骨化醇、骨化三醇和帕立骨化醇。关于CKD儿童和透析患者使用维生素D类似物的研究很少。很难确定能够指导CKD-MBD儿童使用活性维生素D类似物治疗的骨骼特异性结局。欧洲儿科肾脏病学会（ESPN）CKD-MBD和透析工作组的一个核心工作组（WG）制定了关于CKD儿童和透析患者使用活性维生素D治疗的建议。与本文并行的另一篇文档涵盖了天然维生素D治疗的建议。工作组进行了广泛的文献综述，纳入了成人和CKD儿童的系统评价和随机对照试验以及CKD儿童的前瞻性观察性研究。推荐分级、评估、制定和评价（GRADE）系统用于制定和分级这些建议。在缺乏适用研究数据的情况下，提供了ESPN CKD-MBD和透析工作组专家的意见，但明确标记为GRADE等级，治疗医生必须仔细考虑，并根据个体患者需求进行适当调整。
