2017年KDIGO关于慢性肾脏病矿物质及骨异常临床实践指南更新与解读

2009年改善全球肾脏病预后组织(kidney disease:improving global outcomes, KDIGO)发布了关于慢性肾脏病矿物质及骨异常(chronic kidney disease-mineral and bone disorder, CKD-MBD)的诊断、评估、预防和治疗的临床实践指南, 为广大临床工作者对CKD-MBD的认识及诊疗提供了详细的指导意见。但指南缺少针对临床终点事件的随机对照研究(randomized control trial, RCT)证据, 故其证据质量不高。随着此后多项RCT研究和前瞻性队列研究结果的公布, KDIGO工作组经过对相关新证据的评估和充分讨论, 于2017年6月对该指南进行了选择性更新, 主要涉及CKD-MBD中骨病的诊断及钙、磷和甲状旁腺素的管理等。本文就主要的更新内容进行解读, 揭示其临床意义。

Updates and Interpretation on 2017 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for the Diagnosis,Evaluation, Prevention,and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder

The Kidney Disease:Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) was originally published in 2009, which assists practitioners in clinical diagnosis, prevention, and treatment of CKD-MBD. However, the Guideline Work Group acknowledged the lack of sufficient evidence for the base of recommendations. The Guideline included specific research recommendations to encourage investigators to help fill the gaps and bolster the evidence base. With the accumulation of related results of multiple randomized and controlled trials and prospective cohort studies since 2009, 2017 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD represents a selective update on the prior guideline published in 2009. Specifically, the topic areas for which updated recommendations are issued include the diagnosis of bone abnormalities in CKD-MBD, treatment of CKD-MBD by targeting phosphate lowering and calcium maintenance, treatment of parathyroid hormone abnormalities in CKD-MBD, and so on. A total of 12 recommendations were reevaluated and updated based on new data. This report interprets the updates on 2017 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD and describes the results of these proceedings, which highlights the significance of KDIGO CKD-MBD guideline in clinical practice.