慢性肾脏病(CKD)是一个全球性的健康问题,患病率不断上升。影响全球6.975亿人。它带来了巨大的负担,2017年造成3580万残疾调整寿命年(DALYs)和120万死亡。CKD的死亡率在1990年至2017年间增加了41.5%,将其定位为全球死亡的重要原因。CKD与多种健康并发症有关,影响心血管,神经学,营养,和内分泌方面。一个突出的并发症是CKD-矿物质和骨骼疾病(MBD),涉及骨转换失调的复杂状况,矿化,和力量,伴有软组织和血管钙化。矿物质代谢的改变,包括钙,磷酸盐,甲状旁腺激素(PTH),维生素D,成纤维细胞生长因子-23(FGF-23),还有Klotho,在CKD-MBD中起关键作用。这些骚乱,在CKD早期观察到,有助于骨疾病和肾性骨营养不良(ROD)的进展。血管钙化(VC)是CKD-MBD的重要组成部分,CKD加速。病理生理学涉及血管平滑肌细胞的复杂过程和钙蛋白颗粒(CPP)的形成。VC与心血管事件和死亡率密切相关,强调其预后意义。各种血清标志物和成像技术,包括侧线X线,KauppilaScore,Adragao分数,和脉搏波速度,协助VC检测。此外,pQCT提供了关于动脉钙化的有价值的信息,提供优于传统评分系统的优势。CKD构成了巨大的全球健康负担,和它的并发症,包括CKD-MBD和VC,显着导致发病率和死亡率。了解矿物质代谢之间的复杂关系,骨骼疾病,血管钙化对有效诊断和治疗干预至关重要。
Chronic kidney disease (CKD) is a global health issue with a rising prevalence, affecting 697.5 million people worldwide. It imposes a substantial burden, contributing to 35.8 million disability-adjusted life years (DALYs) and 1.2 million deaths in 2017. The mortality rate for CKD has increased by 41.5% between 1990 and 2017, positioning it as a significant cause of global mortality. CKD is associated with diverse health complications, impacting cardiovascular, neurological, nutritional, and endocrine aspects. One prominent complication is CKD-mineral and bone disorder (MBD), a complex condition involving dysregulation of bone turnover, mineralization, and strength, accompanied by soft tissue and vascular calcification. Alterations in mineral metabolism, including calcium, phosphate, parathyroid hormone (PTH), vitamin D, fibroblast growth factor-23 (FGF-23), and Klotho, play pivotal roles in CKD-MBD. These disturbances, observed early in CKD, contribute to the progression of bone disorders and renal osteodystrophy (ROD). Vascular calcification (VC) is a key component of CKD-MBD, accelerated by CKD. The pathophysiology involves complex processes in vascular smooth muscle cells and the formation of calciprotein particles (CPP). VC is closely linked to cardiovascular events and mortality, emphasizing its prognostic significance. Various serum markers and imaging techniques, including lateral plain X-ray, Kauppila Score, Adragao Score, and pulse wave velocity, aid in VC detection. Additionally, pQCT provides valuable information on arterial calcifications, offering an advantage over traditional scoring systems. CKD poses a substantial global health burden, and its complications, including CKD-MBD and VC, significantly contribute to morbidity and mortality. Understanding the intricate relationships between mineral metabolism, bone disorders, and vascular calcification is crucial for effective diagnosis and therapeutic interventions.