中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (06): 441-446.doi: 10.3969/j.issn.1671-4091.2026.06.001

• 临床研究 •    下一篇

中国透析中心慢性肾脏病矿物质和骨代谢异常与贫血管理现状：DOPPS医师调查数据

马承前   赵新菊   甘良英   陈育青   侯凡凡    倪兆慧    陈晓农    梁馨苓    左 力   

  1. 100044 北京，1北京大学人民医院肾内科
    100034 北京，2北京大学第一医院肾内科
    510515 广州，3南方医科大学南方医院肾内科
    200127 上海，4上海交通大学仁济医院肾内科
    200025 上海，5上海交通大学瑞金医院肾内科
    510000 广州，6广东省医学科学院广东省人民医院肾内科
  • 收稿日期:2025-10-13 修回日期:2026-03-18 出版日期:2026-06-12 发布日期:2026-06-12
  • 通讯作者: 左力,赵新菊 E-mail:zuoli@bjmu.edu.cn；zxjrmyy@163.com
  • 基金资助:
    国家自然科学基金(81870524)

Current situation of CKD-MBD and renal anemia management in Chinese dialysis centers: data from DOPPS medical director surveys

MA Cheng-qian, ZHAO Xin-ju, GAN Liang-ying, CHEN Yu-qing, HOU Fan-fan, NI Zhao-hui, CHEN Xiao-nong, LIANG Xin-ling, ZUO Li   

  1. MA Cheng-qian1, ZHAO Xin-ju1, GAN Liang-ying1, CHEN Yu-qing2, HOU Fan-fan3, NI Zhao-hui4, CHEN Xiao-nong5, LIANG Xin-ling6, ZUO Li
  • Received:2025-10-13 Revised:2026-03-18 Online:2026-06-12 Published:2026-06-12
  • Contact: 100044 北京，北京大学人民医院肾内科 E-mail:zuoli@bjmu.edu.cn；zxjrmyy@163.com

摘要： 目的  基于中国透析预后与实践模式研究(Dialysis Outcomes and Practice Patterns Study，DOPPS)7期医师调查问卷数据，分析北京、广州、上海等43家透析中心对慢性肾脏病矿物质和骨代谢异常(chronic kidney disease-mineral and bone disorder，CKD-MBD)及肾性贫血的治疗现状。 方法 采用横断面调查设计，收集2018—2022年DOPPS 7期研究基线期医师调查问卷数据，分析CKD-MBD(磷结合剂使用、继发性甲状旁腺功能亢进管理)及肾性贫血[红细胞生成素刺激剂(erythropoiesis-stimulating agents,ESA)、铁剂治疗]等临床实践的专家观点及相关指标。 结果 共回收有效问卷43份，其中32份(74.4%)为医疗主任/内科主任医师填写，11份(25.6%)为非主任医师的肾科医师填写。降磷药物方面：67.4%的肾科医生赞同将司维拉姆作为长期一线治疗方案，含钙磷结合剂仍广泛使用(60.5%作为一线方案)。继发性甲状旁腺功能亢进症(secondary hyperparathyroidism，SHPT)治疗方面：93.0%的医师在血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)≤350 pg/ml时启动维生素D治疗，92.7%(38/41)首选口服给药途径。肾性贫血治疗方面：62.8%的医师认同以血红蛋白(hemoglobin，Hb)＜100 g/L为启动ESA治疗的阈值，85.7%的医师以血清铁蛋白(serum ferritin，SF)≤300 ng/ml为启动铁剂治疗的阈值，48.8%的医师以SF≥500 ng/ml为停药阈值。 结论 中国一线城市透析中心在CKD-MBD及肾性贫血治疗中仍存在改进空间。虽然非含钙磷结合剂是主要的一线降磷方案，但含钙磷结合剂仍广泛使用，维生素D给药途径及铁剂治疗时机与当前指南存在偏离。需要规范化实践缩小与指南的差距。

关键词: 慢性肾脏病矿物质与骨代谢异常, 肾性贫血, 血液透析, DOPPS研究

Abstract: Objective  Based on the data from the medical director survey questionnaire of the 7th phase of the Chinese Dialysis Outcomes and Practice Patterns Study (DOPPS 7), this study analyzed the current treatment practices for chronic kidney disease-mineral and bone disorder (CKD-MBD) and renal anemia in 43 dialysis centers in Beijing, Guangzhou, and Shanghai.  Methods  A cross-sectional survey design was adopted. Data from the medical director surveys of DOPPS 7 (2018 to 2021) were collected and analyzed for practice indicators such as CKD-MBD (phosphate binder use, secondary hyperparathyroidism management) and renal anemia (erythropoiesis-stimulating agents [ESA], iron therapy). Count data were described as percentages, and the χ² test was used for comparisons between groups (P＜0.05 was considered significant).  Results  Regarding the phosphate binder use: most nephrologists choose sevelamer as the long-term first-line treatment option, but calcium-containing phosphate binders are still widely used. When there are no cost limits, most doctors prefer non-calcium-containing phosphate binders mainly due to the risk of hypercalcemia. Concerning the treatment of hyperparathyroidism: most physicians consider a parathyroid hormone (PTH) level of 300 pg/mL as the critical value for initiating vitamin D therapy, and 92.7% prefer oral administration. For the treatment of renal anemia: most physicians concur that a hemoglobin (Hb) level of ＜100 g/L serves as the threshold for initiating erythropoiesis-stimulating agent (ESA) treatment, and a ferritin level of ≤300 ng/mL is regarded as the threshold for commencing iron supplementation. Notably, only 48.8% of centers adopt a ferritin level of ≥500 ng/mL as the cut-off point for discontinuing treatment.  Conclusion  There is room for improvement in the treatment of CKD-MBD and renal anemia in dialysis centers in China's first-tier cities. Although non-calcium-containing binders are the main first-line hypophosphatemia treatment, calcium-containing phosphate binders are still widely used. The administration route of vitamin D and the timing of iron therapy deviate from current guidelines. Standardized practices are needed to narrow the gap with the guidelines.

Key words: Chronic kidney disease-mineral and bone disorder, Renal anemia, Hemodialysis, DOPPS study

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