Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy.
Renal Unit, University of Campania "L. Vanvitelli'', 80138 Naples, Italy.
Int J Mol Sci. 2022 Oct 13;23(20):12223. doi: 10.3390/ijms232012223.
Chronic kidney disease (CKD) is a complex and multifactorial disease, and one of the most prevalent worldwide. Chronic kidney disease-mineral bone disorders (CKD-MBD) with biochemical and hormonal alterations are part of the complications associated with the progression of CKD. Pathophysiology of CKD-MBD focused on abnormalities in serum levels of several biomarkers (such as FGF-23, klotho, phosphate, calcium, vitamin D, and PTH) which are discussed in this review. We therefore examine the prognostic association between CKD-MBD and the increased risk for cardiovascular events, mortality, and CKD progression to end-stage kidney disease (ESKD). Lastly, we present specific treatments acting on CKD to prevent and treat the complications associated with secondary hyperparathyroidism (SHPT): control of hyperphosphatemia (with dietary restriction, intestinal phosphate binders, and adequate dialysis), the use of calcimimetic agents, vitamin D, and analogues, and the use of bisphosphonates or denosumab in patients with osteoporosis.
慢性肾脏病（CKD）是一种复杂的多因素疾病，也是全球最普遍的疾病之一。慢性肾脏病-矿物质和骨异常（CKD-MBD）伴有生化和激素改变，是与 CKD 进展相关的并发症之一。CKD-MBD 的病理生理学主要关注几种生物标志物（如 FGF-23、klotho、磷酸盐、钙、维生素 D 和 PTH）的血清水平异常，这在本综述中进行了讨论。因此，我们研究了 CKD-MBD 与心血管事件风险增加、死亡率以及 CKD 进展至终末期肾病（ESKD）之间的预后相关性。最后，我们介绍了针对 CKD 的具体治疗方法，以预防和治疗继发性甲状旁腺功能亢进症（SHPT）相关并发症：控制高磷血症（通过饮食限制、肠道磷结合剂和充分透析）、使用拟钙剂、维生素 D 及其类似物，以及在骨质疏松症患者中使用双膦酸盐或地舒单抗。
