osphate?Parathyroid hormone?Vitamin DРBone turnover?Mineralisation?Volume?Linear growth?StrengthРVascular or ?soft tissue calcificationРMoe et al KI 2006Р高磷血症的危害Р死亡率增加Р高磷血症Р继发性甲旁亢Р骨代谢紊乱Р血管及软组织钙化Р抑制活性vitD合成Р血磷水平每升高1mg/dl, CKD患者死亡风险升高18%РJAMA 2011,305:1119-1127РBlock GA et al. JASN 2004;15:2208–18РN = 40,538Р血磷, mg/dLР< 3?(< 0.97)Р4–5?(1.3–1.6)Р5–6?(1.6–1.9)Р6–7?(1.9–2.3)Р7–8?(2.3–2.6)Р8–9?(2.6–2.9)Р> 9?(> 2.9)Р3–4?(0.97–1.3)Р0.0Р0.2Р0.4Р0.6Р0.8Р1.0Р1.2Р1.4Р1.6Р1.8Р2.0Р2.2Р死亡风险(RR, 95% CI)РK/DOQI ?目标范围?3.5–5.5 mg/dL?(1.1–1.78 mmol/L)Р2.4Р高磷血症是死亡率的一个独立危险因素Р高磷血症治疗及磷结合剂选择Р随CKD进展,血磷水平逐渐升高Р10РCraver L, et al. Nephrol Dial Transplan. 2007;22(4):1171-1176.Р*P <0.05 CKD3 vs CKD4; **P <0.05 CKD4 vs CKD5Р3.0Р3.5Р4.0Р4.5Р5.0Р5.5Р血磷平均浓度(mg/dL)РCKD1期РCKD2期РCKD3期РCKD4期РCKD5期Р*Р**Р血磷水平从CKD3期开始呈进行性上升,4期显著升高
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