Nephrol Dial Transplant (2004) 19: I9-I13
Nephrol Dial Transplant Vol. 19 Suppl 1 © ERA-EDTA 2004; all rights reserved
The importance of bone health in end-stage renal disease: out of the frying pan, into the fire?
Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, KY, USA
Correspondence and offprint requests to: Professor Dr Hartmut H. Malluche, Division of Nephrology, Bone and Mineral Metabolism, Room MN 564, UK Medical Center, 800 Rose Street, Lexington, KY 40536-0084, USA. Email: hhmall{at}uky.edu
Abstract
In the early stages of renal failure, hyperparathyroidism develops as a compensatory mechanism to control serum levels of calcium, phosphorus and calcitriol. As kidney disease progresses, this ability to maintain mineral homeostasis is lost, leading to the development of renal osteodystrophy (ROD). Over the past decade, the pattern of ROD seen in patients with chronic kidney disease (CKD) has changed. Previously, the majority of patients had mixed uraemic osteodystrophy or aluminium-related osteomalacia. The decreased use of aluminium-based phosphate binders, coupled with improvements in the management of hyperphosphataemia, led to a reduction in the prevalence of these types of ROD. Since the mid-1990s, there has been an increase in the prevalence of adynamic bone disease as a result of increased suppression of parathyroid hormone through the use of calcium-based phosphate binders and calcitriol therapy. Adynamic bone disease is also associated with several clinical factors, such as older age, use of continuous ambulatory peritoneal dialysis and the presence of diabetes mellitus, as well as the use of calcitriol therapy. Studies of calcium metabolism in patients with CKD have shown that adynamic bone disease is a distinct clinical condition that leads to hypercalcaemia via mechanisms different from that seen in high-turnover bone disease. As high calcium x phosphorus product has been associated with soft tissue and vascular calcifications, and increased mortality, optimizing bone health may be an important way of reducing cardiovascular risk in patients with CKD. To do this, novel, effective, non-calcium, non-aluminium phosphate binders will be necessary.
Keywords: adynamic bone disease; bone turnover; calcitriol; extraosseous calcification; hyperparathyroidism; parathyroid hormone; renal bone disease
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. Evenepoel, R. Selgas, F. Caputo, L. Foggensteiner, J. G. Heaf, A. Ortiz, A. Kelly, S. Chasan-Taber, A. Duggal, and S. Fan Efficacy and safety of sevelamer hydrochloride and calcium acetate in patients on peritoneal dialysis Nephrol. Dial. Transplant., January 1, 2009; 24(1): 278 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Floege Reply Nephrol. Dial. Transplant., December 1, 2008; 23(12): 4082 - 4083. [Full Text] [PDF]
|
|
|
|
 |
|
 V. M. Brandenburg and J. Floege Adynamic bone disease--bone and beyond NDT Plus, June 1, 2008; 1(3): 135 - 147. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Saab, A. T. Whaley-Connell, R. Khanna, and J. R. Sowers Review: Therapy for the altered mineral metabolism of chronic kidney disease: implications for vascular calcification Therapeutic Advances in Cardiovascular Disease, December 1, 2007; 1(2): 107 - 112. [Abstract] [PDF]
|
|
|
|
|
|
A. Galassi, D. M. Spiegel, A. Bellasi, G. A. Block, and P. Raggi Accelerated vascular calcification and relative hypoparathyroidism in incident haemodialysis diabetic patients receiving calcium binders Nephrol. Dial. Transplant., November 1, 2006; 21(11): 3215 - 3222. [Abstract] [Full Text] [PDF]
|
|