CKD-MBD治疗策略以Ｐ的管理为中心.ppt

14-42 43-52 53-60 61-72 73-132 2.0 1.5 1.0 0.5 REFERENCE 1.06 1.08 1.00 1.13 1.34* *P0.01 RR Relative mortality risk by Ca×PO4 product quintiles (N=2669). The vertical bars indicate the 5% to 95% confidence intervals. Am J Kidney Dis: 1998: 31: 607-617 Ca×PO4 Product Quintile (mg2/dl2) * ppt课件 与死亡相关的因子 Population Attributable Risk Percent Block G, J Am Soc Neph 15: 2208-2218, 2004 10 5 15 0 (%) 20 Low URR ＜65 Anemia Hb＜11 All Minerals High PO4 ＞1.6 ＞5.0 High Ca ＞2.5 ＞10.0 High PTH ＞60 ＞600 Population Attributable Risk Percent HD: 40,538, FMC-NA * ppt课件 Cannata-Andia, J. B. et al. J Am Soc Nephrol 2006;17:S267-S273 透析患者与一般人的大动脉钙化病变的研究 Age, gender match * ppt课件 动脉钙化与心血管死亡有关 Arterial Calcifications and Cardiovascular Risk in End-Stage Renal Disease Blacher J et al., Hypertension (2001) 38: 938 * ppt课件 钙化进展与值 Stompór TP et al.,AJKD2004；44：517-28 In univariate analysis, ΔCaSc did not show a significant correlation with any of the tested parameters of lipid profile, cytokines, or acute-phase proteins. No correlation was found between ΔCaSc and age, dialysis vintage R P Calcium ?0.12 　 0.37 Phosphate 0.44 　0.0005 Ca × P product 0.38 　0.003 iPTH ?0.10 　0.42 PD patients 61, CAC score 0 and 12 months * ppt课件 CAC score increase on the age in 39 Children and Young Adults with HD Goodman WG et al : NEJM.Vol342(20) ; 1478-1483, 2000 Calcification Score Age (years) 10,000 1,000 100 10 1 0 0 5 10 15 20 25 30 35 * ppt课件 Ca和P代谢的治疗目标变化 P ＞ Ca ＞ PTH 昔 今 PTH ＞ Ca ＞ P * ppt课件 Guidelines for CKD-MBD, Stage 5d Origin Year Ca, mg/dL P, mg/dL Ca x P PTH pg/mL CARI 2000 8.8~10.4 6.8 Pref5.6 71.9 2~3x limit EDTA 2001 8.8~11.0 2.5~4.6 55 EBPG 2002 3.5~5.5 55 150~300 K/DOQI 2003 10.2 Pref8.4~9.5 3.5~5.5 55 150~300 UK 2002 8.8~10.4 5.6 4x limit JSDT 2006 8.4~10.0 3.5~6.0 60~180 * ppt课件 PB磷吸附能 CaCO3 (g) Ca acetate (g) Sevelamer (g) Lanthanum (g) Ca含有 400mg 250mg — — 磷吸附 (mg/ｇ) 44mg 50mg 33mg 115mg 3g能吸附的磷的量 132mg 150mg — — 吸附300mg磷所需要的量 7.0g 6.0g 9.1g＝37片 2.