地舒单抗对慢性肾脏病患者的骨保护作用

Osteoprotective effect of denosumab on patients with chronic kidney disease

骨质疏松症是慢性肾脏病(chronic kidney disease,CKD)的合并症或并发症。低骨密度、骨质疏松症及骨折是CKD患者预后不良的风险因素,积极防治CKD患者骨质疏松症至关重要。地舒单抗是靶向核因子κB受体活化因子配体的全人源单克隆抗体,不经肾脏代谢或排泄。临床研究表明,不同阶段CKD(包括透析、肾移植)合并骨质疏松症患者使用地舒单抗后可增加骨密度,降低骨折风险,安全性良好。需要注意的是,CKD患者发生低钙血症的风险较高,在使用地舒单抗之前,需要密切监测并提前补充钙和维生素D,在治疗期间需要监测血钙水平。该文就地舒单抗在CKD患者的骨保护作用研究进展作一综述。

Osteoporosis is a comorbidity or complication of chronic kidney disease(CKD).Low bone mineral density,osteoporosis,and fractures are risk factors of poor prognosis in patients with CKD.Active prevention and treatment of osteoporosis is essential for patients with CKD.Denosumab is a fully human monoclonal antibody that targets receptor activator of nuclear factor-κB ligand(RANKL)and is not metabolized or excreted by the kidney.Clinical studies have shown that the use of denosumab in CKD(including dialysis and renal transplantation)patients with osteoporosis,can increase bone mineral density and reduce the incidence of fractures with acceptable safety.As hypocalcemia has been observed in patients with CKD,close monitoring and early supplementation of calcium and vitamin D are required before denosumab initiation,and serum calcium levels need to be monitored during treatment.The review summarized the published literature of denosumab in bone protection of CKD.