Chronic Kidney Disease –Mineral Bone Disorder (CKD- MBD) – Further Insight at the Indian patients.
Abstract
The kidneys play an important role in maintaining normal serum calcium (Ca) and phosphorous (P) concentrations. Chronic kidney disease (CKD) is associated with significant disturbances in bone and mineral metabolism, leading to altered serum concentrations of Ca, P, vitamin D and parathyroid hormone (PTH)1,2,3. These changes are initially detected when the glomerular filtration rate (GFR) falls to ≤60 mL/min and are nearly uniform as GFR drops to <30ml/min2,3. This leads to a number of bone abnormalities previously called “renal osteodystrophy”, renamed as CKD-Mineral Bone Disorder (CKD-MBD) by National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) consensus group4 . CKD-MBD is a systemic disorder manifested by either one or a combination of a) abnormalities of Ca, P, PTH or vitamin D metabolism, b) abnormalities in bone turnover, mineralization, volume, linear growth or strength c) vascular or soft tissue calcification. This has over time been expanded to include left ventricular hypertrophy, hypertension, immune dysfunction and inflammation5,6.
Downloads
References
2. Fukagawa M, Komaba H. Chronic Kidney Disease-Mineral and Bone Disorder in Asia. Kidney Dis 2017; 3:1-7.
3. Etta PK, Sharma R K, Gupta A. Study of chronic kidney disease-mineral bone disorders in newly detected advanced renal failure patients: A Hospital-based cross-sectional study. Saudi J Kidney Dis Transpl 2017; 28:874-85
4. Moe S, Drueke T, Cunningham J. Definition, evaluation and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global outcomes (KDIGO). Kidney Int 2006; 69:1945-53.
5. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int (S) 2009;113: S1-130.
6. Uhlig K, Berns JS, Kestenbaum B et al. KDOQI US commentary on the 2009 KDIGO clinical practice guidline for the diagnosis, evaluation and treatment of CKD-MBD. Am J Kidney Dis 2010; 55:773-99.
7. Kestenbaum B, Sampson JN, Rudser KD et al. Serum phosphate levels and mortality risk among people with chronic kidney disease. J m Soc Nephrol 2005; 16:520-8.
8. Wilson PW, Kauppila LI, O’Donnell CJ, et al. Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation 2001; 103:1529-34.
9. Fletcher S, Jones RG, Rayner HC, et al. Assessment of renal osteodystrophy in dialysis patients: Use of bone alkaline phosphatase, bone mineral density and parathyroid ultrasound in comparison with bone histology. Nephron 1997; 75:412-9.
10. Agarwal SK. Assessment of renal bone mineral disorder in naïve CKD patients: A single center prospective study. Ind J Nephrol. 2007; 17:96-100.
11. Ghosh B, Brojen T, Banerjee S, et al. The high prevalence of chronic kidney disease-mineral bone disorders: A hospital-based cross-sectional study. Indian J Nephrol 2012; 22:285-91.
12. Valson AT, Sundaram M, David VG, et al. Profile of incident chronic kidney disease related-mineral bone disorders in chronic kidney disease stage 4 and 5: A hospital based cross-sectional survey. Ind J Nephrol 2014; 24:97-107
13. Vikrant S, Parashar A. Prevalence and severity of disordered mineral metabolism in patients with chronic kidney disease: A study from a tertiary care hospital in India. Ind J Endocr Metab 2016; 20:460-67.
14. Jabbar Z, Aggarwal PK, Chandel N, et al. Noninvasive assessment of bone health in Indian patients with chronic kidney disease. Indian J Nephrol 2013; 23:161-7
15. Sheikh RY, Bhat N, Chowdhury A, Bandyopadhay A. Spectrum of mineral bone disorder in patients with CKD stage 3-5 from eastern India. J of Medical Sciences 2019: 22(3).
