慢性肾脏疾病-矿物质和骨骼疾病(CKD-MBD)包括实验室和骨骼异常以及血管钙化,并对临床结果产生有害影响。KDOQI(肾脏疾病结果质量倡议),国家肾脏基金会的倡议,在2003年和2年后发表的CKD骨代谢和疾病临床实践指南中解决了这个问题,CKD-MBD的新定义和分类方案是在KDIGO(肾脏疾病:改善全球结果)争议会议之后制定的.关于CKD-MBD的最初KDIGO指南随后于2009年发布。随后在2013年KDIGO争议会议上审查了新证据,2017年,KDIGO发布了临床实践指南更新,评估,预防,和CKD-MBD的治疗。本评论介绍了由国家肾脏基金会召集的KDOQICKD-MBD工作组的观点。KDOQI工作组同意大多数KDIGO指南更新建议,特别是关于骨密度测试的建议,对矿物质代谢标志物纵向趋势的联合评估,饮食磷酸盐咨询侧重于磷酸盐添加剂。然而,KDOQI工作组对与低钙血症和高钙血症相关的建议有一些担忧,磷酸盐粘合剂的选择,和治疗甲状旁腺激素浓度异常。本评论的总体目标是为美国肾脏病界提供关于CKD-MBD及其诊断的广泛讨论,预防,和治疗。
Chronic kidney disease-mineral and bone disorder (CKD-MBD) encompasses laboratory and bone abnormalities and vascular calcification and has deleterious effects on clinical outcomes. KDOQI (Kidney Disease Outcomes Quality Initiative), an initiative of the National Kidney Foundation, addressed this issue with the publication of a clinical practice
guideline for bone metabolism and disease in CKD in 2003, and 2 years later, a new definition and classification scheme for CKD-MBD was developed following a KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference. The initial KDIGO
guideline on CKD-MBD was then published in 2009. New evidence was subsequently reviewed at the 2013 KDIGO Controversies Conference, and in 2017, KDIGO issued a clinical practice
guideline update for the diagnosis, evaluation, prevention, and treatment of CKD-MBD. This commentary presents the views of the KDOQI CKD-MBD work group convened by the National Kidney Foundation. The KDOQI work group agrees with most of the KDIGO
guideline update recommendations, particularly the suggestions regarding bone mineral density testing, joint assessments of longitudinal trends in mineral metabolism markers, and dietary phosphate counseling focused on phosphate additives. However, the KDOQI work group has some concerns about the suggestions related to hypocalcemia and hypercalcemia, phosphate-binder choice, and treatment of abnormal parathyroid hormone concentrations. The overall goal of this commentary is to provide a broad discussion for the US nephrology community regarding CKD-MBD and its diagnosis, prevention, and treatment.