美国对二次性甲状腺功能障碍症的治疗实践模式:来自修改后的Delphi小组的结果
David E Henner1, Beatrice Drambarean2, Teresa M Gerbeling3
1Division of Nephrology, Berkshire Medical Center, Pittsfield, MA, United States of America.
PloS one
|January 31, 2025
概括
专家的共识定义了慢性脏病 (CKD) 中的二次性甲状腺功能障碍症 (SHPT) 管理. 早期治疗至关重要,对维生素D类似物和仿药有特殊偏好,尽管非证据因素会影响决策.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 二次性偏甲状腺症 (SHPT) 在慢性病 (CKD) 患者中很普遍.
- 现有的病改善全球结果 (KDIGO) 准则存在局限性,原因是证据不足和新药的批准.
- 一个专家小组试图在美国脏病学界建立关于SHPT管理实践的共识.
研究的目的:
- 确定美国对二次性副甲状腺功能障碍症 (SHPT) 实践模式的专家共识.
- 将当前的实践与最新的指导方针和现实世界的临床背景保持一致.
- 确定与现有的KDIGO建议达成一致和分歧的领域.
主要方法:
- 一种经过修改的Delphi方法,涉及10名美国医疗保健提供者和1名患者.
- 基于代问卷的共识建立在三个阶段.
- 利用了2009年和2017年的KDIGO指南和文献,达成共识的协议门为66%.
主要成果:
- 在第三阶段,对100%的问题达成共识.
- 一致同意,SHPT治疗往往是迟迟开始的.
- 对于血清酸盐<4.6 mg/dL,血清<9.5 mg/dL,维生素D类似物 (非透析) 和静脉化剂 (透析) 确立了偏好.
结论:
- 专家共识为SHPT管理和药物使用提供了精细的策略.
- 强调对SHPT的早期干预至关重要.
- 承认非基于证据的因素,如配方药和保险,会对治疗决策产生重大影响.
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