Klinikum Coburg, Coburg, Germany, and University of Split School of Medicine, Split, Croatia (M.K.).
Denver Nephrology, Denver, Colorado (G.A.B.).
Ann Intern Med. 2018 Mar 20;168(6):422-430. doi: 10.7326/M17-2640. Epub 2018 Feb 20.
The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a selective update of the prior CKD-MBD guideline published in 2009. The guideline update and the original publication are intended to assist practitioners caring for adults with CKD and those receiving long-term dialysis.
Development of the guideline update followed an explicit process of evidence review and appraisal. The approach adopted by the Work Group and the evidence review team was based on systematic reviews of relevant trials, appraisal of the quality of the evidence, and rating of the strength of recommendations according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Searches of the English-language literature were conducted through September 2015 and were supplemented with targeted searches through February 2017. Final modification of the guidelines was informed by a public review process involving numerous stakeholders, including patients, subject matter experts, and industry and national organizations.
The update process resulted in the revision of 15 recommendations. This synopsis focuses primarily on recommendations for diagnosis of and testing for CKD-MBD and treatment of CKD-MBD that emphasizes decreasing phosphate levels, maintaining calcium levels, and addressing elevated parathyroid hormone levels in adults with CKD stage G3a to G5 and those receiving dialysis. Key elements include basing treatment on trends in laboratory values rather than a single abnormal result and being cautious to avoid hypercalcemia when treating secondary hyperparathyroidism.
《肾脏病：改善全球预后（KDIGO）2017 年慢性肾脏病-矿物质和骨异常（CKD-MBD）诊断、评估、预防和治疗临床实践指南更新》是 2009 年发布的 CKD-MBD 指南的选择性更新。本指南更新和原始出版物旨在帮助治疗 CKD 成人和长期接受透析治疗患者的临床医生。
指南更新的制定遵循明确的证据审查和评估过程。工作组和证据审查小组采用的方法是基于对相关试验的系统评价、证据质量评估以及根据 GRADE（推荐评估、制定与评价）方法对推荐强度进行分级。对英文文献的检索截至 2015 年 9 月，并通过 2017 年 2 月的针对性检索进行补充。公众审查过程参与了众多利益相关者，包括患者、主题专家以及行业和国家组织，为指南的最终修订提供了信息。
更新过程导致 15 项建议被修订。本概要主要侧重于 CKD-MBD 的诊断和检测以及 CKD-MBD 治疗的建议，重点是降低磷水平、维持钙水平以及解决 CKD 3a 期至 5 期和接受透析治疗的成人甲状旁腺激素水平升高的问题。关键要素包括根据实验室值的趋势而非单个异常结果进行治疗，以及在治疗继发性甲状旁腺功能亢进症时要谨慎避免高钙血症。
