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

Kamyar Kalantar-Zadeh, Anuja Shah, Uyen Duong, Rulin C. Hechter, Ramanath Dukkipati, Csaba Kovesdy

Research output: Contribution to journalReview article

82 Citations (Scopus)

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-B ligand modulators (denosumab); compare mortality predictability of PTH and alkaline phosphatase; and examine potential risks of bone disorders and mineral disarrays in CKD patients.

Original languageEnglish (US)
JournalKidney International
Volume78
Issue numberSUPPL. 117
DOIs
StatePublished - Aug 1 2010

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Bone Diseases
Kidney Diseases
Chronic Renal Insufficiency
Vitamin D
Vitamin D Deficiency
Minerals
Alkaline Phosphatase
Vascular Calcification
Mortality
Calcitriol
Parathyroid Hormone
Bone and Bones
Parathyroid Hormone Receptor Type 1
Teriparatide
Chronic Kidney Disease-Mineral and Bone Disorder
Hypophosphatemia
Ergocalciferols
Calcitriol Receptors
Secondary Hyperparathyroidism
Hypocalcemia

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Kidney bone disease and mortality in CKD : Revisiting the role of vitamin D, calcimimetics, alkaline phosphatase, and minerals. / Kalantar-Zadeh, Kamyar; Shah, Anuja; Duong, Uyen; Hechter, Rulin C.; Dukkipati, Ramanath; Kovesdy, Csaba.

In: Kidney International, Vol. 78, No. SUPPL. 117, 01.08.2010.

Research output: Contribution to journalReview article

Kalantar-Zadeh, Kamyar ; Shah, Anuja ; Duong, Uyen ; Hechter, Rulin C. ; Dukkipati, Ramanath ; Kovesdy, Csaba. / Kidney bone disease and mortality in CKD : Revisiting the role of vitamin D, calcimimetics, alkaline phosphatase, and minerals. In: Kidney International. 2010 ; Vol. 78, No. SUPPL. 117.
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