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., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
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].
