巴西肾性骨营养不良概述：一项横断面研究。

Overview of renal osteodystrophy in Brazil: a cross-sectional study.

机构信息

Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Divisão de Nefrologia, Campinas, SP, Brazil.

Universidade Estadual de Campinas, Faculdade de Ciências Médicas da Campinas, Laboratório para o Estudo do Metabolismo Mineral e Ósseo em Nefrologia, Campinas, Campinas, SP, Brazil.

出版信息

J Bras Nefrol. 2023 Apr-Jun;45(2):257-261. doi: 10.1590/2175-8239-JBN-2022-0146en.

DOI:10.1590/2175-8239-JBN-2022-0146en

PMID:37158484

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10627135/

Abstract

INTRODUCTION

The epidemiologic profile of renal osteodystrophy (ROD) is changing over time and cross-sectional studies provide essential information to improve care and health policies. The Brazilian Registry of Bone Biopsy (REBRABO) is a prospective, nationalmulticenter cohort that includes patients with chronic kidney disease (CKD) undergoing bone biopsy. REBRABO aims to provide clinical information on ROD. The main objective of this subanalysis was to describe the profile of ROD, including clinically relevant associations.

METHODS

From Aug/2015 to Dec/2021, 511 patients with CKD who performed bone biopsy were included in the REBRABO platform. Patients with no bone biopsy report (N = 40), GFR > 90 mL/min (N = 28), without asigned consent (N = 24), bone fragments inadequate for diagnosis (N = 23), bone biopsy indicated by a specialty other than nephrology (N = 6), and < 18 years old (N = 4) were excluded. Clinical-demographic data (e.g., age, sex, ethnicity, CKD etiology, dialysis vintage, comorbidities, symptoms, and complications related to ROD), laboratory (e.g., serum levels of total calcium, phosphate, parathormone, alkaline phosphatase, 25-hydroxyvitamin D, and hemoglobin), and ROD (e.g., histological diagnosis) were analyzed.

RESULTS

Data from 386 individuals were considered in this subanalysis of REBRABO. Mean age was 52 (42-60) years; 198 (51%) were male; 315 (82%) were on hemodialysis. Osteitis fibrosa (OF) [163 (42%)], adynamic bone disease (ABD) [96 (25%)] and mixed uremic osteodystrophy (MUO) [83 (21%)] were the most frequent diagnosis of ROD in our sample; 203 (54%) had the diagnosis of osteoporosis, 82 (56%) vascular calcification; 138 (36%) bone aluminum accumulation, and 137 (36%) iron intoxication; patients with high turnover were prone to present a higher frequency of symptoms.

CONCLUSIONS

A high proportion of patients were diagnosed with OF and ABD, as well as osteoporosis, vascular calcification and clinical symptoms.

摘要

简介

肾性骨营养不良（ROD）的流行病学特征随时间而变化，横断面研究为改善护理和卫生政策提供了重要信息。巴西骨活检登记处（REBRABO）是一个前瞻性的全国多中心队列，纳入了接受骨活检的慢性肾脏病（CKD）患者。REBRABO 的目的是提供 ROD 的临床信息。本次亚分析的主要目的是描述 ROD 的特征，包括临床相关关联。

方法

从 2015 年 8 月至 2021 年 12 月，共有 511 例接受骨活检的 CKD 患者纳入 REBRABO 平台。排除无骨活检报告（N=40）、肾小球滤过率（GFR）>90 mL/min（N=28）、未签署同意书（N=24）、骨碎片不足以诊断（N=23）、由肾病以外的专科进行骨活检（N=6）和<18 岁（N=4）的患者。分析临床-人口统计学数据（例如年龄、性别、种族、CKD 病因、透析龄、合并症、症状和 ROD 相关并发症）、实验室数据（例如血清总钙、磷、甲状旁腺素、碱性磷酸酶、25-羟维生素 D 和血红蛋白）和 ROD（例如组织学诊断）。

结果

在本次 REBRABO 的亚分析中，共纳入 386 名个体的数据。平均年龄为 52（42-60）岁；198 名（51%）为男性；315 名（82%）接受血液透析。纤维性骨炎（OF）[163 名（42%）]、动力性骨病（ABD）[96 名（25%）]和混合性尿毒症性骨营养不良（MUO）[83 名（21%）]是我们样本中最常见的 ROD 诊断；203 名（54%）患有骨质疏松症，82 名（56%）患有血管钙化；138 名（36%）有铝蓄积，137 名（36%）有铁中毒；高转化率患者更易出现症状。