Chronic kidney disease–mineral and bone disorder

Chronic kidney disease–mineral and bone disorder (CKD–MBD) is one of the many complications associated with

• Abnormalities of calcium, phosphorus (phosphate), parathyroid hormone, or vitamin D metabolism
• Abnormalities in
  mineralization
  , volume, linear growth, or strength
• Vascular or other soft-tissue calcification

CKD–MBD explains, at least in part, the high morbidity and mortality of CKD patients, linking kidney and bone disease with cardiovascular complications. It is a matter of discussion whether CKD–MBD may be considered a real syndrome or not.^[3]

CKD–MBD broadens the "old" concept of "

Presentation

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Pathophysiology

It is well known that as kidney function declines, there is a progressive deterioration in mineral homeostasis, with a disruption of normal serum and tissue concentrations of

Numerous cohort studies have shown associations between disorders of mineral metabolism and fractures, cardiovascular disease, and mortality.[2] These observational studies have broadened the focus of CKD-related mineral and bone disorders (MBDs) to include cardiovascular disease (which is the leading cause of death in patients at all stages of CKD).^[2] All three of these processes (abnormal mineral metabolism, abnormal bone, and extraskeletal calcification) are closely interrelated and together make a major contribution to the morbidity and mortality of patients with CKD.^[2] The traditional definition of renal osteodystrophy did not accurately encompass this more diverse clinical spectrum, based on serum biomarkers, noninvasive imaging, and bone abnormalities. The absence of a generally accepted definition and diagnosis of renal osteodystrophy prompted Kidney Disease: Improving Global Outcomes (KDIGO) to sponsor a controversies conference, entitled Definition, Evaluation, and Classification of Renal Osteodystrophy, in 2005. The principal conclusion was that the term CKD–Mineral and Bone Disorder (CKD–MBD) should now be used to describe the "broader clinical syndrome encompassing mineral, bone, and calcific cardiovascular abnormalities that develop as a complication of CKD".^[1][2]

Diagnosis

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Treatment

Treatment efforts may involve many clinical and diagnostic manoeuvers, such as trying to decrease phosphate,^[7] normalize vitamin D (calcidiol levels) or decrease PTH and/or alkaline phosphatase levels.^[8] However, there is an important lack of randomized clinical studies and recent guidelines (KDIGO 2017) have been recently released on the topic. Although it was previously considered, normalization of calcemia is not included in modern treatment goals since the advent of calcimimetics.^[5]

References