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Bone and mineral disorders in pre-dialysis CKD

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An Erratum to this article was published on 23 April 2008

Abstract

Disorders in calcium, phosphorus, and parathyroid hormone (PTH) are common in chronic kidney disease (CKD) and may be associated with poor outcomes including a higher rate of CKD progression and increased death risk. Although these abnormalities have been examined extensively in patients with CKD stage 5 who are receiving chronic maintenance dialysis, they have not been studied to the same extent at earlier stages of CKD, in spite of the much larger numbers of patients in the early CKD population. We summarize the available literature on outcomes associated with bone and mineral disorders in patients with CKD not yet receiving maintenance dialysis. We have reviewed novel data linking fibroblast growth factor 23 (FGF-23) to phosphorus and vitamin D homeostasis. More rapid CKD progression is linked to hyperphosphatemia and its associated hyperparathyroidism and vitamin D deficiency. Hence, hyperphosphatemia may play a central role in the diverse disorders characterizing CKD. We provide a brief overview of the available treatment recommendations for bone and mineral disorders, with an emphasis on areas needing further research.

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Abbreviations

CKD:

Chronic kidney disease

PTH:

Parathyroid hormone

FGF-23:

Fibroblast growth factor 23

MHD:

Maintenance hemodialysis

MBD:

Mineral and bone disorder

SHPT:

Secondary hyperparathyroidism

GFR:

Glomerular filtration rate

MDRD:

Modification of diet in renal disease

CV:

Cardiovascular

AASK:

African American study of hypertension and kidney Disease

1,25(OH)2D:

1,25-Dihydroxycholecalciferol

ESRD:

End stage renal disease

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Acknowledgements

Conflict of interest

Csaba P. Kovesdy and Kamyar Kalantar-Zadeh have received grants and/or honoraria from Amgen (manufacturer of Sensipar™), Abbott (manufacturer of Calcijex™ and Zemplar™), Genzyme (manufacturer of Hectorol™, Renagel™ and Renvela™), and/or Shire (manufacturer of Fosrenol™).

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Authors and Affiliations

  1. Division of Nephrology, Salem VA Medical Center, 1970 Roanoke Boulevard, Salem, VA, 24153, USA

    Csaba P. Kovesdy

  2. University of Virginia, Charlottesville, VA, USA

    Csaba P. Kovesdy

  3. Harold Simmons Center for Kidney Disease Research and Epidemiology, Torrance, CA, 90502, USA

    Kamyar Kalantar-Zadeh

  4. Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA

    Kamyar Kalantar-Zadeh

  5. David Geffen School of Medicine at UCLA, Torrance, CA, 90502, USA

    Kamyar Kalantar-Zadeh

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  1. Csaba P. Kovesdy
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  2. Kamyar Kalantar-Zadeh
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Correspondence to Csaba P. Kovesdy.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s11255-008-9389-9

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Kovesdy, C.P., Kalantar-Zadeh, K. Bone and mineral disorders in pre-dialysis CKD. Int Urol Nephrol 40, 427–440 (2008). https://doi.org/10.1007/s11255-008-9346-7

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  • DOI: https://doi.org/10.1007/s11255-008-9346-7

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