Update on the treatment of chronic kidney disease-mineral and bone disorder.
Chronic kidney disease (CKD) is associated with increased morbidity and mortality. Mineral metabolism disturbances appear to contribute to the high mortality rate. A CKD-mineral bone disorder (CKD-MBD) has recently been defined as a systemic disorder manifested by one or a combination of abnormalities in bone biopsy, laboratory parameters and/or vascular or other soft-tissue calcifications. New available treatments have contributed to move from the former treatment paradigm of renal osteodystrophy to CKD-MBD management, beyond mere control of parathyroid hormone (PTH) and trying to improve cardiovascular or survival outcomes. Thus, the recommended multidisciplinary approach among nurses, dieticians and clinicians, helping not only through dietary assessment but also through education, behaviour control and by increasing the patient's personal motivation, may have additional important benefits. This article will review the current therapeutic approach with phosphate binders including the latest developments, vitamin D derivatives and selective vitamin D receptor activators as well as the new calcimimetics, all used in the treatment of this systemic disease.
Bover
Jordi
J
Fundació Puigvert and Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain. jbover@fundacio-puigvert.es
Farré
Neus
N
Andrés
Enric
E
Canal
Cristina
C
Olaya
María Teresa
MT
Alonso
Maite
M
Quílez
Begoña
B
Ballarín
José
J
D017607:Aluminum Compounds / Q000627:therapeutic use; D002114:Calcinosis / Q000209:etiology; D002119:Calcium Carbonate / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D000069449:Cinacalcet; D018753:Diet, Protein-Restricted / Q000379:methods; D004046:Dietetics / Q000193:education / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D007811:Lanthanum / Q000627:therapeutic use; D009281:Naphthalenes / Q000627:therapeutic use; D009398:Nephrology / Q000379:methods / Q000592:standards / Q000639:trends; D015596:Nutrition Assessment; D009753:Nutritive Value; D016105:Parathyroidectomy; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic; D010758:Phosphorus / Q000032:analysis; D011073:Polyamines / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D000069603:Sevelamer; D014807:Vitamin D / Q000031:analogs & derivatives
D017607:Aluminum Compounds; D002614:Chelating Agents; D009281:Naphthalenes; D011073:Polyamines; D014807:Vitamin D; D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer; D002119:Calcium Carbonate; D000069449:Cinacalcet