慢性肾脏病(CKD)与多种骨骼疾病和钙磷代谢紊乱有关。与慢性肾脏疾病相关的骨疾病具有较高的CKD进展率和增加的死亡风险。为了查看血清钙的状态,磷酸和完整的甲状旁腺激素在透析前CKD(3至5期)患者。这是在国家肾脏疾病和泌尿外科研究所的肾脏病门诊部进行的跨部门研究,达卡,2012年6月1日至2013年5月31日。CKD3、4、5期尚未透析的患者就诊于肾内科,根据K/DOQI指南使用MDRD-4方程并回顾以前的医疗记录和调查报告,NIKDU被纳入本研究。血清钙(校正血清白蛋白)后,测量磷酸盐和iPTH水平,并与K/DOQI指南中推荐的目标范围进行比较.根据K/DOQI指南对不同阶段CKD(3,4,5)具有血清水平的患者人数如下:血清钙:56.6、58.5和76.7;血清磷酸盐:55.2、58.5和56.7;iPTH分别为37.9、12.2和36.7以及CaxP乘积100.0、97.6和86.7。根据第3、4和5阶段的K/DOQI指南,血清钙水平在以下范围内的患者(接受药物)百分比如下:血清钙:63.2%,分别为64.7%和83.3%;血清磷酸盐:63.2%,61.8%和66.7%;分别iPTH42.1%,14.7%和4.7%,CaxP产品100.0%,100.0%和87.5%,分别。另一方面,未接受药物治疗的患者,根据K/DOQI指南,CKD3、4和5期患者血清钙水平的百分比如下:血清钙:50.0%,28.6%和50.0%;分别血清磷酸盐:40.0%,42.9%和16.7%;分别iPTH30.0%,14.7%和16.7%,CaxP产品100.0%,85.7%和83.3%,分别。达到K/DOQI指南的四项建议的患者在第3阶段为4(13.8%),在第4阶段为3(7.3%),在第5阶段为5(16.7%)。超过一半的CKD透析前患者在K/DOQI指南中推荐的血清钙和磷酸盐的目标范围内,并且在同时服用磷酸盐结合剂和Vit-D的患者中,这一比例更高。几乎所有患者的CaxP都在目标范围内,因此它可能不是治疗决策的重要参数。然而,即使血清钙和磷酸盐水平正常,大多数患者仍超出iPTH的目标范围。因此,应重视CKD早期iPTH水平的监测。
The chronic kidney disease (CKD) is associated with a variety of bone disorders and disorders of calcium and phosphorus metabolism. Bone disease associated with chronic kidney disease having higher rate of CKD progression and increased risk of death. To see the status of serum calcium, phosphate and intact parathyroid hormone in pre-dialysis CKD (stage- 3 to 5) patients. This was a across sectional study done in outpatient department of Nephrology of National Institute of Kidney Diseases and Urology, Dhaka, between 1st June 2012 to 31st May 2013. The patients of CKD stage 3, 4 and 5 yet not on dialysis attending out patients department of Nephrology, NIKDU by using MDRD-4 equation according to K/DOQI
guidelines and reviewing previous medical records and investigation reports were enrolled in this study. There after serum calcium (corrected for serum albumin), phosphate and iPTH levels were measured and compared with the recommended target ranges in K/DOQI
guideline. The number of patients with serum levels according to K/DOQI
guidelines for different stages CKD(3,4,5) were as follows: serum calcium: 56.6, 58.5 and 76.7; serum phosphate: 55.2, 58.5 and 56.7; iPTH 37.9, 12.2 and 36.7 and Ca x P product 100.0, 97.6 and 86.7, respectively. The percentages of patients (who received drug) with serum calcium levels within according to K/DOQI guidelines for stages 3, 4 and 5 were as follows: serum calcium: 63.2%, 64.7% and 83.3%; respectively, serum phosphate: 63.2%, 61.8% and 66.7%; respectively, iPTH 42.1%, 14.7% and 4.7% and Ca x P product 100.0%, 100.0% and 87.5%, respectively. On the other hand patients who didn\'t receive drug the percentages of patients with serum calcium levels according to K/DOQI guidelines for CKD stages 3, 4 and 5 were as follows: serum calcium: 50.0%, 28.6% and 50.0%; respectively, serum phosphate: 40.0%, 42.9% and 16.7%; respectively, iPTH 30.0%, 14.7% and 16.7% and Ca x P product 100.0%, 85.7% and 83.3%, respectively. The patients achieving the four recommendations of K/DOQI
guidelines was 4(13.8%) in stage-3, 3(7.3%) in stage-4 and 5(16.7%) in stage-5. More than half of the pre-dialysis patients of CKD were within target range of serum calcium and phosphate recommended in K/DOQI
guideline and this proportion was more in those who were taking both phosphate binder and Vit-D. Ca x P was within target range in almost all patients so it may not be an important parameter for therapeutic decision making. However majority of the patients were out of target range of iPTH even though having normal serum calcium and phosphate level. So emphasis should be given in monitoring of iPTH level in early stages of CKD.