International Urology and Nephrology

, Volume 40, Issue 2, pp 427–440

Bone and mineral disorders in pre-dialysis CKD

Review

DOI: 10.1007/s11255-008-9346-7

Cite this article as:
Kovesdy, C.P. & Kalantar-Zadeh, K. Int Urol Nephrol (2008) 40: 427. doi:10.1007/s11255-008-9346-7

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.

Keywords

Chronic kidney diseaseParathyroid hormoneHyperphosphatemiaMortalityFGF-231,25-Dihydroxy-cholecalciferol

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

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Division of NephrologySalem VA Medical CenterSalemUSA
  2. 2.University of VirginiaCharlottesvilleUSA
  3. 3.Harold Simmons Center for Kidney Disease Research and EpidemiologyTorranceUSA
  4. 4.Division of Nephrology and HypertensionLos Angeles Biomedical Research Institute at Harbor-UCLA Medical CenterTorranceUSA
  5. 5.David Geffen School of Medicine at UCLATorranceUSA