David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Nephrology, Department of Medical Affairs, Amgen Inc., Thousand Oaks, California.
J Ren Nutr. 2021 Jan;31(1):21-34. doi: 10.1053/j.jrn.2020.02.003. Epub 2020 May 5.
Bone and mineral metabolism becomes dysregulated with progression of chronic kidney disease (CKD), and increasing levels of parathyroid hormone serve as an adaptive response to maintain normal phosphorus and calcium levels. In end-stage renal disease, this response becomes maladaptive and high levels of phosphorus may occur. We summarize strategies to control hyperphosphatemia based on a systematic literature review of clinical trial and real-world observational data on phosphorus control in hemodialysis patients with CKD-mineral bone disorder (CKD-MBD). These studies suggest that current management options (diet and lifestyle changes; regular dialysis treatment; and use of phosphate binders, vitamin D, calcimimetics) have their own benefits and limitations with variable clinical outcomes. A more integrated approach to phosphorus control in dialysis patients may be necessary, incorporating measurement of multiple biomarkers of CKD-MBD pathophysiology (calcium, phosphorus, and parathyroid hormone) and correlation between diet adjustments and CKD-MBD drugs, which may facilitate improved patient management.
随着慢性肾脏病（CKD）的进展，骨和矿物质代谢会失调，甲状旁腺激素水平的升高则作为一种适应性反应，以维持正常的磷和钙水平。在终末期肾病中，这种反应变得不适应，可能会出现高磷血症。我们根据对 CKD-矿物质骨病（CKD-MBD）血液透析患者磷控制的临床试验和真实世界观察数据的系统文献综述，总结了控制高磷血症的策略。这些研究表明，目前的管理选择（饮食和生活方式的改变；定期透析治疗；以及使用磷结合剂、维生素 D、钙敏感受体激动剂）具有各自的优缺点，临床结果也存在差异。对于透析患者的磷控制，可能需要采取更综合的方法，包括测量 CKD-MBD 病理生理学的多个生物标志物（钙、磷和甲状旁腺激素），以及饮食调整与 CKD-MBD 药物之间的相关性，这可能有助于改善患者的管理。
