Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBDs): What the Endocrinologist Needs to Know |
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| Institution: | 1. Endocrine, Diabetes & Osteoporosis Clinic (EDOC), Sterling, VA;2. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota;3. Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio;4. University of Colorado Health Sciences Center, Colorado Center for Bone Research.;1. Harold Simmons Center for Kidney Disease Research & Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA;2. Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA;3. Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada;4. Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN, USA;5. University of Tennessee Health Science Center, Memphis, TN, USA;6. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA;7. Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea;1. Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine School of Medicine, Orange, California, USA;2. Kaiser Permanente, Los Angeles, California, USA;3. DaVita, El Segundo, California, USA;4. David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA;5. University of Tennessee Health Science Center, Memphis, Tennessee, USA;6. Memphis VA Medical Center, Memphis, Tennessee, USA;7. Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, USA;1. Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan;2. Department of Medicine and Clinical Medicine, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan;3. Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan |
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| Abstract: | ObjectiveChronic kidney disease-mineral and bone disorders (CKD-MBDs) are a spectrum of abnormalities involving skeletal hormones, minerals, and bone turnover and mineralization. This paper focuses on what the endocrinologist should know about the assessment and management of skeletal and metabolic disorders in CKD-MBDs.MethodsRelevant literature was reviewed to (1) define disturbances of minerals and hormones in the course of CKD; (2) identify the variable radiographic and histomorphometric changes of CKD-MBDs; (3) review the association among CKD-MBDs, vascular calcification, cardiovascular disease (CVD), and mortality; and (4) clarify issues in CKD-MBDs therapy.ResultsAssessment and treatment of CKD-MBDs is complicated by progressive changes in bone minerals and skeletal regulatory hormones as kidney function declines. CKD-MBDs are associated with fracture risk, and studies demonstrate that bone mineral density can be used to assess bone loss and fracture risk in these patients. Treatment of CKD-MBDs continues to evolve. Use of calcium, phosphate binders, vitamin D, vitamin D–receptor analogs, and drugs for osteoporosis and CKD-MBDs treatment are discussed in the context of safety and efficacy for patients with CKD.ConclusionThe association of CKD with bone disease, vascular calcification, CVD, and mortality mandates earlier recognition and treatment of CKD-MBDs. Osteoporosis as a distinct entity can be diagnosed and managed in CKD, although assessment of osteoporosis becomes challenging in late (stage 4 to 5) CKD. Diabetes is common in early (stage 1 to 3) CKD. In addition, 96% of all individuals identified as having CKD have early CKD. The endocrinologist is uniquely positioned to address and treat both diabetes and many of the metabolic and skeletal disorders associated with early CKD-MBDs, including osteoporosis. (Endocr Pract. 2014;20:500-516) |
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