钙片及维生素D 是治疗普通人群骨质疏松的基础用药,也是治疗慢性肾脏病矿物质骨代谢障碍(CKD-MBD)的常用药。 然而,它们在CKD 人群中的用药原则及方法与普通人群有明显差别。 钙片除了补充元素钙,还主要作为磷结合剂而被广泛应用。 碳酸钙及醋酸钙由于元素钙含量高、胃酸中溶解度大、价格较低等特点而成为磷结合剂的首选。 钙片的主要弊端在于机体钙负荷的增加,使血管钙化及心血管疾病的风险增大。 同样,与普通人群服用的维生素D 制剂不同,CKD 中晚期患者须服用活性维生素D,它不仅可以补充维生素D 的不足与缺乏,还可有效抑制继发性甲状旁腺功能亢进,调节免疫、减轻蛋白尿、改善胰岛素抵抗、减少心血管事件的作用,并有可能延缓肾衰竭的进展。

Calcium and active vitamin D are useful in the management of osteoporosis and chronic kidney disease (CKD)-mineral and bone disorder (CKD-MBD). However, it is important to realize the difference between their uses in general population and in CKD patients. In addition to supplementing calcium, calcium agent, as phosphate binder, is also widely used. Due to their high calcium content and high solubility in gastric acidic environment with lower prices, calcium carbonate and calcium acetate have become the first choice as phosphate binders. The main disadvantage of calcium tablet is that it can increase the body's calcium load, and increase the risk of vascular calcification and cardiovascular disease. Similarly,while the general population take vitamin D supplements, patients with CKD at moderate to severe stage must take active vitamin D. Active vitamin D can not only complement the vitamin D deficiency, but also effectively suppress secondary hyperparathyroidism, regulate immunity, reduce proteinuria, improve insulin resistance, and reduce cardiovascular events, and may have a role to delay the progression of renal failure.