Chronic Kidney Disease associated Mineral bone disorder

Chronic Kidney Disease associated Mineral bone disorder

(also called secondary hyperparathyroidism or renal osteodystrophy):

Disordered mineral bone metabolism is a common complication of chronic kidney disease (CKD).  It usually starts in patients with CKD stage 3 and is present in almost all patients on dialysis.  Mineral bone disorder can be detected long before any symptoms are present by performing routine blood work.  Special attention must be given to treating this disorder.  If left untreated it can lead to calcification of the blood vessels and the soft tissue and to weaker bones.

The kidneys are responsible for the excretion of the daily food load of phosphorus and for the activation of vitamin D.  Thus, insufficient kidney function results in low calcium level, and high phosphorus and parathyroid hormone (PTH) levels.  PTH is a hormone produced by the parathyroid glands that is pivotal in the bone metabolism.  The management of these disorders involves the control of phosphorus, calcium, vitamin D, and PTH levels as follows:

  • Phosphorus: Patients may need to avoid certain foods that are naturally rich in phosphorus or that have phosphorus containing preservatives.  Certain medications called phosphorus binders are also very helpful, because they reduce the amount of phosphorus that is absorbed by the gastrointestinal tract.  For that purpose they need to be taken with meals. Patients on dialysis may also get some phosphorus removed during dialysis sessions.
  • Vitamin D: It may be necessary for a patient to take vitamin D if their blood level is low.
  • PTH: High phosphorus and low calcium levels in the blood are the main stimuli for the secretion of PTH.  If despite their control a patient’s PTH level is still high, it may be necessary to use medications, such as active vitamin D analogs or calcimimetics, which help controlling the PTH levels. Occasionally, some patients may need surgery for removal of the parathyroid glands.

For further information, visit the following websites:

National Kidney Foundation: www.kidney.org

National Kidney Disease Education Program: www.nkdep.nih.gov

American Association of Kidney Patients: www.aakp.org

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