活性维生素D及其类似物在CKD-MBD中的应用

The use of active vitamin D and its analogues in chronic kidney disease-mineral and bone disorder

慢性肾脏病-矿物质和骨代谢异常(chronic kidney disease-mineral and bone disorder,CKDMBD)是慢性肾脏病(chronic kidney disease,CKD)患者主要的并发症之一,目前CKD-MBD治疗手段主要包括:磷结合剂、活性维生素D及其类似物、拟钙剂等药物治疗以及甲状旁腺手术治疗。其中,活性维生素D及其类似物是最为常见的治疗药物,可以降低甲状旁腺激素(parathyroid hormone,PTH),改善骨质疏松和高转运骨病的骨损害,在临床上应用广泛,但使用不当也会导致高钙、高磷血症及加重血管钙化发展,为了更合理的使用该类药物,本文结合2017年KDIGO的CKD-MBD指南更新并就活性维生素D及其类似物在CKD-MBD的治疗进展进行介绍。

Chronic kidney disease-mineral and bone disorder（CKD-MBD） is one of the major complications and one of the major death causes in CKD patients. Currently, the treatment of CKD-MBD mainly includes phosphorus binding agent, active vitamin D and its analogues, calcimimetics and parathyroidectomy.Active vitamin D and its analogues are widely used clinically, which can reduce parathyroid hormone level and alleviate bone damage of osteoporosis and high transport bone disease. However, inappropriate use of these medications may cause hypercalcemia, hyperphosphatemia and aggravation of vascular calcification.This article introduces recent progresses in the treatment of CKD-MBD using active vitamin D and its analogues as well as the renewal of KDIGO guide 2017 for CKD-MBD.