[The French clinician's guide to the Kidney disease: Improving global outcomes (KDIGO) for chronic kidney disease-mineral and bone disorders (CKD-MBD)].
The new recommendations of "Kidney disease: improving global outcomes" for the definition and classification of chronic kidney disease and mineral and bone disorders were released in August 2009. We report the most important of these recommendations and a brief comment from a clinician's point of view. The main points to be noted with regard to the new recommendations are as follows: serum calcium should be in the normal range; phosphorus concentration should be lowered toward the normal range and serum parathyroid hormone (PTH) levels should be two to nine times the upper limit of the normal range; bone remodelling can be assessed using alkaline phosphatase; the use of calcium-phosphorus (Ca x P) product as an index is not recommended anymore; at any stage of CKD, vitamin D deficiency and insufficiency must be corrected; vascular calcification should be detected in a simple way using lateral abdominal radiography and echocardiography; a bone biopsy should be performed before therapy with bisphosphonates; the prescription of dialysate calcium should be individualized within the range of 1.25-1.5 mmol/l; the phosphate binder (calcium- or non-calcium-based) and the other treatments for secondary hyperparathyroidism should be individualized based on a global strategy. A majority of these recommendations are not based on evidence and their feasibility and relevance need to be assessed.
Jean
G
G
Centre de rein artificiel, 69160 Tassin La Demi-Lune, France. guillaume-jean-crat@wanadoo.fr
Chazot
C
C
D001847:Bone Diseases / Q000209:etiology* / Q000517:prevention & control*; D002128:Calcium Metabolism Disorders / Q000209:etiology* / Q000517:prevention & control*; D002908:Chronic Disease; D005602:France; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D010760:Phosphorus Metabolism Disorders / Q000209:etiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic