Guedes Murilo, Bieber Brian, Dasgupta Indranil, Vega Almudena, Nitta Kosaku, Brunelli Steven, Hartman John, Raimann Jochen G, Robinson Bruce M, Pisoni Ronald L
Pontificia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
Arbor Research Collaborative for Health, Ann Arbor, Michigan.
Kidney Med. 2022 Dec 14;5(2):100584. doi: 10.1016/j.xkme.2022.100584. eCollection 2023 Feb.
Mineral bone disorder (MBD) is a frequent consequence of chronic kidney disease, more so in patients with kidney failure treated by kidney replacement therapy. Despite the wide availability of interventions to control serum phosphate and parathyroid hormone levels, unmet gaps remain on optimal targets and best practices, leading to international practice pattern variations over time. In this Special Report, we describe international trends from the Dialysis Outcomes and Practice Patterns Study (DOPPS) for MBD biomarkers and treatments from 2002-2021, including data from a group of 7 European countries (Belgium, France, Germany, Italy, Spain, Sweden, United Kingdom), Japan, and the United States. From 2002-2012, mean phosphate levels declined in Japan (5.6 to 5.2 mg/dL), Europe (5.5 to 4.9 mg/dL), and the United States (5.7 to 5.0 mg/dL). Since then, levels rose in the United States (to mean 5.6 mg/dL, 2021), were stable in Japan (5.3 mg/dL), and declined in Europe (4.8 mg/dL). In 2021, 52% (United States), 27% (Europe), and 39% (Japan) had phosphate >5.5 mg/dL. In the United States, overall phosphate binder use was stable (80%-84% over 2015-2021), and parathyroid hormone levels rose only modestly. Although these results potentially stem from pervasive knowledge gaps in clinical practice, the noteworthy steady increase in serum phosphate in the United States over the past decades may be consequential to patient outcomes, an uncertainty that hopefully will soon be addressed by ongoing clinical trials. The DOPPS will continue to monitor international trends as new interventions and strategies ensue for MBD management in chronic kidney disease.
矿物质骨病（MBD）是慢性肾脏病的常见后果，在接受肾脏替代治疗的肾衰竭患者中更为常见。尽管有多种控制血清磷酸盐和甲状旁腺激素水平的干预措施，但在最佳目标和最佳实践方面仍存在未满足的差距，导致国际实践模式随时间而变化。在本特别报告中，我们描述了2002年至2021年透析结果和实践模式研究（DOPPS）中MBD生物标志物和治疗方法的国际趋势，包括来自7个欧洲国家（比利时、法国、德国、意大利、西班牙、瑞典、英国）、日本和美国的数据。2002年至2012年期间，日本（从5.6降至5.2mg/dL）、欧洲（从5.5降至4.9mg/dL）和美国（从5.7降至5.0mg/dL）的平均磷酸盐水平下降。从那时起，美国的水平上升（到2021年平均为5.6mg/dL），日本稳定在（5.3mg/dL），欧洲下降至（4.8mg/dL）。2021年，52%（美国）、27%（欧洲）和39%（日本）的磷酸盐>5.5mg/dL。在美国，磷酸盐结合剂的总体使用稳定（2015年至2021年期间为80%-84%），甲状旁腺激素水平仅略有上升。尽管这些结果可能源于临床实践中普遍存在的知识差距，但过去几十年美国血清磷酸盐的显著稳步上升可能会对患者预后产生影响，这种不确定性有望通过正在进行的临床试验很快得到解决。随着慢性肾脏病MBD管理的新干预措施和策略的出现，DOPPS将继续监测国际趋势。
