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Chronic kidney disease-mineral bone disorder (CKD-MBD)
| Content Provider | Semantic Scholar |
|---|---|
| Author | Kiattisunthorn, Kraiwiporn Moe, Sharon M. |
| Copyright Year | 2010 |
| Abstract | Chronic kidney disease-mineral bone disorder (CKD-MBD) is a new term to describe the complex interplay of abnormal mineral metabolism, increased bone fragility and impaired linear bone growth, and vascular calcification in patients with CKD. These abnormalities are more common, and the natural history accelerated, in the setting of CKD. All components of CKD-MBD are associated with increased morbidity and mortality. The pathophysiology of CKD-MBD is just beginning to be understood, offering hope for new therapies to reduce the burden of fractures and cardiovascular disease in patients with CKD. IBMS BoneKEy. 2010 December;7(12):447-457. 2010 International Bone & Mineral Society Chronic kidney disease (CKD) is a worldwide health problem, affecting 13-25% of the population (1-3). Disturbances in mineral metabolism are common complications of CKD, beginning early in the course of progressive CKD. CKD staging is based on estimated glomerular filtration rate (eGFR): CKD stage 3 = eGFR of 60 to 30 ml/min; CKD stage 4 = eGFR of 30-15 ml/min; CKD stage 5 = eGFR < 15 ml/min; and CKD stage 5D are patients on dialysis (4). Beginning in stage 3 CKD, the damaged kidney is unable to fully excrete a phosphorus load nor can it convert vitamin D into its active metabolite 1,25(OH)2D (calcitriol), leading to a compensatory secondary hyperparathyroidism. Elevated PTH and decreased calcitriol levels are found in 40% of patients with an eGFR between 40 and 50 ml/min and in 80% of patients with an eGFR below 20 ml/min (5). In addition, an elevation in FGF23 is also apparent early in the course of CKD (6;7). These mineral and endocrine functions disrupted in CKD are critically important in the regulation of bone remodeling. As a result, bone abnormalities (altered remodeling and loss of bone volume) are found almost universally in patients with CKD requiring dialysis and in the majority of patients with CKD stages 3-5 (8-10). These skeletal changes result in an increased prevalence of hip fracture compared to the general population across the entire range of CKD stages 3-5 and in dialysis patients (11-20). Dialysis patients in their 40s have a relative risk of hip fracture 80-fold that of ageand sex-matched controls (13). In patients with stage 4 CKD, the risk of hip fracture was nearly 4-fold that of the general population without CKD even at advanced ages (17). Furthermore, a hip fracture in patients with a GFR < 45 ml/min or on dialysis is associated with a doubling of the mortality observed in non-dialysis patients with a hip fracture (14;19;21). Derangements in mineral metabolism are also associated with cardiovascular disease and all-cause mortality (22-26). Cardiovascular disease accounts for 70% of all deaths in patients with CKD, with an overall mortality of 20% per year in patients on dialysis (27). In individuals with kidney failure on dialysis, cardiovascular mortality rates are 10to 500-times higher than in the general population, even after adjustment for gender, race, and the presence of diabetes (12). Importantly, individuals at earlier stages of CKD not yet on dialysis (stages 3-4) are up to 17-times more likely to die of cardiovascular disease than they are of progressing to dialysis (25). Multiple cross-sectional studies in dialysis patients IBMS BoneKEy. 2010 December;7(12):447-457 http://www.bonekey-ibms.org/cgi/content/full/ibmske;7/12/447 doi: 10.1138/20100479 |
| Starting Page | 447 |
| Ending Page | 457 |
| Page Count | 11 |
| File Format | PDF HTM / HTML |
| DOI | 10.1138/20100479 |
| Volume Number | 7 |
| Alternate Webpage(s) | http://triggered.edina.clockss.org/ServeContent?url=https://knowledgeenvironment.stanford.clockss.org/2010/bonekey_2010_bonekey20100479_xml_pdf/bonekey20100479.pdf |
| Alternate Webpage(s) | https://doi.org/10.1138/20100479 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
