Management of chronic kidney disease-mineral and bone disorder: Korean working group recommendations.
For Korean dialysis patients, chronic kidney disease-mineral bone disorder is a serious burden because of cardiovascular calcification and mortality. However, recent epidemiologic data have demonstrated that many patients undergoing maintenance hemodialysis are out of the target ranges of serum calcium, phosphorus, and intact parathyroid hormone. Thus, we felt the necessity for the development of practical recommendations to treat abnormal serum phosphorus, calcium, and iPTH in dialysis patients. In this paper, we briefly comment on the measurement of serum calcium, phosphorus, iPTH, dialysate calcium concentration, dietary phosphorus restriction, use of phosphate binders, and medical and surgical options to correct secondary hyperparathyroidism. In particular, for the optimal management of secondary hyperparathyroidism, we suggest a simplified medication adjustment according to certain ranges of serum phosphorus and calcium. Large-scale, well-designed clinical studies are required to support our strategies to control chronic kidney disease-mineral bone disorder in this country. Based on such data, our practice guidelines could be established and better long-term outcomes should be anticipated in our dialysis patients.
Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
Eunah
E
Hwang
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Bum Soon
BS
Choi
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Kook-Hwan
KH
Oh
Division of Nephrology, College of Medicine, Korea University, Guro Hospital, Seoul, Korea.
Young Joo
YJ
Kwon
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Gheun-Ho
GH
Kim
Calcium; Dialysis; Phosphorus; Secondary hyperparathyroidism