Kidney bone disease and mortality in CKD: revisiting the role of vitamin D, calcimimetics, alkaline phosphatase, and minerals.

Abstract

Recent evidence suggests that the traditional syndromes known as renal osteodystrophy, secondary hyperparathyroidism, and vitamin D deficiency are related to mortality in persons with moderate to advanced chronic kidney disease (CKD). The so-called 'kidney bone disease', also known as 'mineral and bone disorders', is defined to include bone disorders, mineral disarrays, and vascular calcification. We have identified 14 common and clinically relevant conditions of contemporary nature that are related to the kidney bone disease, including calcitriol (active vitamin D) deficiency, 25(OH)-vitamin D deficiency, biochemical hyperparathyroidism, relatively low parathyroid hormone (PTH) level, increased serum alkaline phosphatase (hyperphosphatasemia), elevated fibroblast growth factor (FGF)-23, high turnover bone disease, adynamic bone disease, uremic osteoporosis, vascular calcification, hyper- and hypophosphatemia, and hyper- and hypocalcemia. We present a critical review of these 14 conditions with emphasis on patient survival and other pertinent clinical outcomes. We also review unresolved controversies surrounding the management of these conditions by administration of nutritional vitamin D (ergocalciferol and cholecalciferol), vitamin D receptor activators (calcitriol, alphacalcidiol, doxercalciferol), D-mimetics (paricalcitol, maxacalcitol), calcimimetics (cinacalcet), recombinant PTH (teriparatide), and receptor activator of nuclear factor-kappaB ligand modulators (denosumab); compare mortality predictability of PTH and alkaline phosphatase; and examine potential risks of bone disorders and mineral disarrays in CKD patients.

• Authors: Kamyar Kalantar-Zadeh, Anuja Shah, Uyen Duong, Rulin C Hechter, Ramanath Dukkipati, Csaba P Kovesdy
• Journal: Kidney international. Supplement (Kidney Int Suppl) Issue 117 Pg. S10-21 (Aug 2010) ISSN: 0098-6577 [Print] United States
• PMID: 20671739 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Ergocalciferols
• FGF23 protein, human
• Minerals
• Parathyroid Hormone
• Receptors, Calcitriol
• Vitamin D
• 1 alpha-hydroxyergocalciferol
• Fibroblast Growth Factors
• paricalcitol
• Fibroblast Growth Factor-23
• Alkaline Phosphatase
• Calcitriol

Topics

• Alkaline Phosphatase (blood)
• Calcinosis (etiology)
• Calcitriol (blood, therapeutic use)
• Chronic Kidney Disease-Mineral and Bone Disorder (complications, etiology)
• Ergocalciferols (therapeutic use)
• Fibroblast Growth Factor-23
• Fibroblast Growth Factors (physiology)
• Humans
• Hypercalcemia (etiology)
• Hyperparathyroidism, Secondary (etiology)
• Hyperphosphatemia (etiology)
• Hypocalcemia (etiology)
• Hypophosphatemia (etiology)
• Kidney Failure, Chronic (complications)
• Minerals
• Osteoporosis (etiology)
• Parathyroid Hormone (blood)
• Receptors, Calcitriol (drug effects)
• Vitamin D (blood)
• Vitamin D Deficiency (blood, etiology)