Calcium Balance in Uremia: Longitudinal Study of Long-Term Survivors

Schuster, Victor L.; Chesnut, Charles H.; Baylink, David J.; Sherrard, Donald J.

doi:10.1159/000183568

Cited by 5 publications

(1 citation statement)

References 27 publications

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“…Figure 1 shows the average values of BMD in studies of patients with CKD Stage 5D 4–6,12,13,16,29–76 . These values are expressed as Z ‐scores, which compare BMD in the patients with the BMD from the reference values of age‐ and gender‐matched persons in the community.…”

Section: Bone Density Measurements In Patients Receiving Haemodialysismentioning

confidence: 99%

Review article: Bone density in patients with chronic kidney disease stages 4‐5

Ott

2009

Nephrology

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SUMMARY:Skeletal fractures are common in dialysis patients. Bone density measurements predict fractures in the general population, but in patients with chronic kidney disease (CKD) there is limited ability to predict fractures with these techniques. A review of the literature in patients with CKD stage 5 shows that bone density in the cortical bone of the radius or hip is generally lower compared with normal reference ranges by about one to two standard deviations, whereas in the spine bone density tends to be closer to the average expected values. The bone density is not able to predict the underlying histology in patients with renal osteodystrophy. The serum PTH levels are inversely related to bone density in some studies, and not related in other studies, but none found a positive association of serum parathyroid hormone (PTH) and bone density. There are very few data about longitudinal changes of bone density in these patients, and also inadequate studies of whether osteoporosis medications are effective in this population. Therefore, at this time the clinical utility of bone density measurements in patients with CKD-5 is uncertain.

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Section: Bone Density Measurements In Patients Receiving Haemodialysismentioning

confidence: 99%

Review article: Bone density in patients with chronic kidney disease stages 4‐5

Ott

2009

Nephrology

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Bone metabolism and disease in chronic kidney disease

Eknoyan¹,

Levin²,

Levin³

2003

American Journal of Kidney Diseases

1,182

377

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Chapter 3.1: Diagnosis of CKD–MBD: biochemical abnormalities

2009

Kidney International

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Biochemical abnormalities are common in chronic kidney disease (CKD) and are the primary indicators by which the diagnosis and management of CKD-mineral and bone disorder (CKD-MBD) is made. The two other components of CKD-MBD (bone abnormalities and vascular calcification) are discussed in Chapters 3.2 and 3.3. RECOMMENDATIONS 3.1.1 We recommend monitoring serum levels of calcium, phosphorus, PTH, and alkaline phosphatase activity beginning in CKD stage 3 (1C). In children, we suggest such monitoring beginning in CKD stage 2 (2D). 3.1.2 In patients with CKD stages 3-5D, it is reasonable to base the frequency of monitoring serum calcium, phosphorus, and PTH on the presence and magnitude of abnormalities, and the rate of progression of CKD (not graded). Reasonable monitoring intervals would be: K In CKD stage 3: for serum calcium and phosphorus, every 6-12 months; and for PTH, based on baseline level and CKD progression. K In CKD stage 4: for serum calcium and phosphorus, every 3-6 months; and for PTH, every 6-12 months.K In CKD stages 5, including 5D: for serum calcium and phosphorus, every 1-3 months; and for PTH, every 3-6 months.K In CKD stages 4-5D: for alkaline phosphatase activity, every 12 months, or more frequently in the presence of elevated PTH (see Chapter 3.2).In CKD patients receiving treatments for CKD-MBD, or in whom biochemical abnormalities are identified, it is reasonable to increase the frequency of measurements to monitor for trends and treatment efficacy and side-effects (not graded). 3.1.3In patients with CKD stages 3-5D, we suggest that 25(OH)D (calcidiol) levels might be measured, and repeated testing determined by baseline values and therapeutic interventions (2C). We suggest that vitamin D deficiency and insufficiency be corrected using treatment strategies recommended for the general population (2C). 3.1.4 In patients with CKD stages 3-5D, we recommend that therapeutic decisions be based on trends rather than on a single laboratory value, taking into account all available CKD-MBD assessments (1C). 3.1.5 In patients with CKD stages 3-5D, we suggest that individual values of serum calcium and phosphorus, evaluated together, be used to guide clinical practice rather than the mathematical construct of calcium-phosphorus product (Ca Â P) (2D). 3.1.6 In reports of laboratory tests for patients with CKD stages 3-5D, we recommend that clinical laboratories inform clinicians of the actual assay method in use and report any change in methods, sample source (plasma or serum), and handling specifications to facilitate the appropriate interpretation of biochemistry data (1B). Summary of rationale for recommendationsK As the diagnosis of CKD-MBD depends on the measurement of laboratory and other variables, it is important to provide a guide to clinicians regarding when to commence measurement of those variables. Although changes in the biochemical abnormalities of CKD-MBD may begin in CKD stage 3, the rate of change and severity of abnormalities are highly variable among patients.K Thus, the recommend...

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Calcium Balance in Uremia: Longitudinal Study of Long-Term Survivors

Cited by 5 publications

References 27 publications

Review article: Bone density in patients with chronic kidney disease stages 4‐5

Review article: Bone density in patients with chronic kidney disease stages 4‐5

Bone metabolism and disease in chronic kidney disease

Chapter 3.1: Diagnosis of CKD–MBD: biochemical abnormalities

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