Bone Disease in Chronic Kidney Disease and Kidney Transplant

Abstract

Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) comprises alterations in calcium, phosphorus, parathyroid hormone (PTH), vitamin D, and fibroblast growth factor-23 (FGF-23) metabolism, abnormalities in bone turnover, mineralization, volume, linear growth or strength, and vascular calcification leading to an increase in bone fractures and vascular disease, which ultimately result in high morbidity and mortality. The bone component of CKD-MBD, referred to as renal osteodystrophy, starts early during the course of CKD as a result of the effects of progressive reduction in kidney function which modify the tight interaction between mineral, hormonal, and other biochemical mediators of cell function that ultimately lead to bone disease. In addition, other factors, such as osteoporosis not apparently dependent on the typical pathophysiologic abnormalities resulting from altered kidney function, may accompany the different varieties of renal osteodystrophy leading to an increment in the risk of bone fracture. After kidney transplantation, these bone alterations and others directly associated or not with changes in kidney function may persist, progress or transform into a different entity due to new pathogenetic mechanisms. With time, these alterations may improve or worsen depending to a large extent on the restoration of kidney function and correction of the metabolic abnormalities developed during the course of CKD. In this paper, we review the bone lesions that occur during both CKD progression and after kidney transplant and analyze the factors involved in their pathogenesis as a means to raise awareness of their complexity and interrelationship.

A comparison of health‐related quality of life in chronic intestinal failure and end‐stage kidney disease: A cross‐sectional study

“…CKD, but the underlying pathophysiologic mechanisms differ. [37][38][39][40] Lastly, people undergoing both treatments may experience emotional and psychological stress due to their medical condition and treatment. 41,42 It has previously been established that both people with CIF and receiving HD have significantly poorer HRQOL compared with the general population.…”

“…Both HPS and HD treatment require careful monitoring of the persons condition and response to treatment, including laboratory tests, vital signs, and fluid and electrolyte balance. Anemia and metabolic bone disease are known complications of both IF and CKD, but the underlying pathophysiologic mechanisms differ 37–40 . Lastly, people undergoing both treatments may experience emotional and psychological stress due to their medical condition and treatment 41,42 …”

Cardiovascular Consequences of Uremic Metabolites: an Overview of the Involved Signaling Pathways

“…27 Moreover, CKD, bone homeostasis, and metabolic acidosis (MAc) are interrelated, meaning that prolonged MAc, as well as kidney-modulated parathyroid hormone secretion, can decrease bone density. 29,30…”

“…27 Moreover, CKD, bone homeostasis, and metabolic acidosis (MAc) are interrelated, meaning that prolonged MAc, as well as kidney-modulated parathyroid hormone secretion, can decrease bone density. 29,30 Thus, CKD contributes to disturbed mineral metabolism, worsens bone microstructure, leads to bone fragility, and creates a favorable environment promoting vascular calcification.…”

Osteoporosis and dermatoporosis: a review on the role of vitamin D

“…Chronic renal failure causes the condition named as “Chronic Kidney Disease-Mineral and Bone Disorder” (CKD-MBD) which is characterized by a group of alterations in calcium-phosphorus metabolism, changes in hormones involved in bone homeostasis such as parathyroid hormone (PTH), VD and fibroblast growth factor-23 (FGF-23), anomalies in bone turnover and mineralization, and vascular calcification. The risk of fracture and vascular disease increases as a result of all these factors ( 46 ). Dermatoporosis and chronic renal failure have also been linked in a strong, age-independent way ( 28 , 42 ).…”