CKD-MINERAL AND BONE DISORDER

SUMMARY

1. Chronic kidney disease-mineral bone disorders (CKD-MBD) = high PO₄ + low/normal Ca + high PTH + low activated Vit D.

2. As GFR declines, PO₄ excreation decreases, levels remain normal until ~ stage 3 CKD.

3. PO₄ accumulation stimulates PTH release => leads to increased bone calcium resorption => Ca + PO₄ deposit in the vasculature & tissue. Low GFR leads to decreased activated Vit D.

4. Hyperphosphatemia is associated with an increased risk of death and heart disease. Treat with phosphate-binders, which can be calcium based (not used now), non-calcium-based (sevelamer/Renagel).

5. Ideal management is to control phosphorus with diet and binder, which leads to normalization of phosphorous, increased Ca, and decreased iPTH.

Reference(s)

Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].