Abrita Rodrigo Reis, Pereira Beatriz Dos Santos, Fernandes Neimar da Silva, Abrita Renata, Huaira Rosalia Maria Nunes Henriques, Bastos Marcus Gomes, Fernandes Natália Maria da Silva
Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.
Centro de Ensino Superior de Juiz de Fora, Passos, Juiz de Fora, MG, Brasil.
J Bras Nefrol. 2018 Jan-Mar;40(1):26-34. doi: 10.1590/2175-8239-JBN-3527. Epub 2018 May 7.
The diagnosis and treatment of mineral and bone disorder of chronic kidney disease (CKD-MBD) is a challenge for nephrologists and health managers. The aim of this study was to evaluate the prevalence, biochemical profile, and drugs associated with CKD-MBD.
Cross-sectional study between July and November 2013, with 1134 patients on dialysis. Sociodemographic, clinical, and laboratory data were compared between groups based on levels of intact parathyroid hormone (iPTH) (< 150, 150-300, 301-600, 601-1000, and > 1001 pg/mL).
The mean age was 57.3 ± 14.4 years. The prevalence of iPTH < 150 pg/mL was 23.4% and iPTH > 601 pg/mL was 27.1%. The comparison between the groups showed that the level of iPTH decreased with increasing age. Diabetic patients had a higher prevalence of iPTH < 150 pg/mL (27.6%). Hyperphosphatemia (> 5.5 mg/dL) was observed in 35.8%. Calcium carbonate was used by 50.5%, sevelamer by 14.7%, 40% of patients had used some form of vitamin D and 3.5% used cinacalcet. Linear regression analysis showed a significant negative association between iPTH, age, and diabetes mellitus and a significant positive association between iPTH and dialysis time.
The prevalence of patients outside the target for iPTH was 50.5%. There was a high prevalence of hyperphosphatemia (35.8%), and the minority of patients were using active vitamin D, vitamin D analogs, selective vitamin D receptor activators, and cinacalcet. These data indicate the need for better compliance with clinical guidelines and public policies on the supply of drugs associated with CKD-MBD.
慢性肾脏病矿物质和骨异常（CKD-MBD）的诊断和治疗对肾脏病学家和卫生管理人员来说是一项挑战。本研究的目的是评估CKD-MBD的患病率、生化特征以及与之相关的药物。
2013年7月至11月进行的横断面研究，纳入1134例透析患者。根据全段甲状旁腺激素（iPTH）水平（<150、150 - 300、301 - 600、601 - 1000及>1001 pg/mL）对各亚组的社会人口学、临床和实验室数据进行比较。
平均年龄为57.3±14.4岁。iPTH<150 pg/mL的患病率为23.4%，iPTH>601 pg/mL的患病率为27.1%。各亚组间比较显示，iPTH水平随年龄增长而降低。糖尿病患者中iPTH<150 pg/mL的患病率较高（27.6%）。高磷血症（>5.5 mg/dL）的发生率为35.8%。50.5%的患者使用碳酸钙，14.7%的患者使用司维拉姆，40%的患者使用过某种形式的维生素D，3.5%的患者使用西那卡塞。线性回归分析显示，iPTH与年龄、糖尿病之间存在显著负相关，iPTH与透析时间之间存在显著正相关。
iPTH未达目标值的患者患病率为50.5%。高磷血症患病率较高（35.8%），少数患者使用活性维生素D、维生素D类似物、选择性维生素D受体激动剂和西那卡塞。这些数据表明，需要更好地遵守关于CKD-MBD相关药物供应的临床指南和公共政策。
