title: [How to manage mineral metabolism disorders in renal failure].
abstract: Mineral metabolism abnormalities are frequently observed in patients with chronic kidney disease (CKD). The bone and cardiovascular consequences should lead to the implementation of some adapted strategies for the prevention and treatment on the basis of the physiopathology of the disease and international recommendations. Biological bone markers such as serum parathyroid hormone (PTH) and alkaline phosphatase (ALP) are necessary to classify bone diseases without the need for bone biopsy. Elevated levels of bone markers are detected in cases of secondary hyperparathyroidism (SHPT), whereas decreased levels are observed in cases of adynamic bone disease (ABD). Bone mineral density, however, is not useful for the diagnosis. Vitamin D supplementation and reducing hyperphosphataemia by dietary phosphate-intake restriction, phosphate binders, and dialysis, are the main steps for the prevention of SHPT. Calcitriol analogs and calcimimetics should be used in second line in cases of SHPT. For the treatment of ABD, excess use of calcium salts and calcitriol analogs need to be avoided. Managing these therapies adequately can help maintain the main biological values (i.e. serum PTH, calcium, phosphorus, and ALP) within their recommended ranges.
authors: Centre de rein artificiel, 42, avenue du 8-mai-1945, 69160 Tassin La Demi-Lune, France. guillaume-jean-crat@wanadoo.fr
authors: Guillaume
authors: G
authors: Jean
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D057966:Calcimimetic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002117:Calcitriol / Q000008:administration & dosage / Q000031:analogs & derivatives; D002119:Calcium Carbonate / Q000008:administration & dosage / Q000009:adverse effects; D002614:Chelating Agents / Q000627:therapeutic use; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D054559:Hyperphosphatemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D016226:Phosphorus, Dietary / Q000008:administration & dosage / Q000009:adverse effects; D011237:Predictive Value of Tests; D017582:Renal Replacement Therapy
chemical_list: D057966:Calcimimetic Agents; D002614:Chelating Agents; D010281:Parathyroid Hormone; D016226:Phosphorus, Dietary; D000469:Alkaline Phosphatase; D002117:Calcitriol; D002119:Calcium Carbonate