拟钙剂治疗维持性血液透析患者继发性甲状旁腺功能亢进症的中国专家共识(2024版)  

Consensus of Chinese experts on the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients with calcimimetics(2024 edition)

作　　者：拟钙剂治疗MHD患者SHPT专家共识工作组 左力[2] 甘良英 Expert consensus working group on the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients with calcimimetics;ZUO Li(Zhongguancun Nephrology&Blood Purification Innovation Alliance;不详)

机构地区：[1]中关村肾病血液净化创新联盟 [2]北京大学人民医院肾内科,北京100044

出　　处：《中国血液净化》2024年第10期721-735,共15页Chinese Journal of Blood Purification

摘　　要：继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)是慢性肾脏病-矿物质和骨异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)的重要临床表现,严重影响维持性血液透析患者的预后。拟钙剂通过激活钙敏感受体(calcium-sensing receptor,CaSR),可有效降低甲状旁腺激素(parathyroid hormone,PTH)水平,且不增加高钙血症和血管钙化风险。为规范和优化拟钙剂在SHPT治疗中的应用,本共识基于系统文献回顾,结合我国临床实践和专家经验,按照“循证为主,共识为辅,经验为鉴”的原则,制定了相关的推荐意见。通过名义组法,共达成了14条推荐意见,涵盖了拟钙剂在SHPT治疗中的用药时机、临床疗效、特殊人群应用、联合治疗以及临床应用的安全性。共识还详细阐述了拟钙剂的使用方法、监测指标及不良反应管理,为各级医疗机构医师使用拟钙剂提供科学指导,旨在提升治疗效果和改善患者预后。Secondary hyperparathyroidism(SHPT)is a critical clinical manifestation of chronic kidney disease-mineral and bone disorder(CKD-MBD),significantly impacting the prognosis of maintenance hemodialysis patients.Calcimimetics activate the calcium-sensing receptor(CaSR),effectively reducing parathyroid hormone(PTH)levels without increasing the risks of hypercalcemia and vascular calcification.To standardize and optimize the use of calcimimetics in SHPT treatment,this consensus was developed through a systematic literature review,integrating with clinical practices and expert experiences in China,following the principles of‘evidence-based first,consensus supplementary,experience as reference’.Utilizing the nominal group technique,14 recommendations were established,covering the timing of drug administration,clinical efficacy,use in special populations,combination therapy,and clinical safety of calcimimetics in SHPT treatment.The consensus also provides detailed guidelines on the utilization,monitoring indicators,and management of adverse reactions of calcimimetics,providing scientific guidance for clinicians in various medical institutions to improve treatment outcomes and patient prognosis.

关 键 词：拟钙剂 维持性血液透析 继发性甲状旁腺功能亢进症 甲状旁腺激素 

分 类 号：R459.5[医药卫生—治疗学]