Executive summary of the 2017 KDIGO Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters

Abstract

The KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD represents a selective update of the prior CKD-MBD Guideline published in 2009. This update, along with the 2009 publication, is intended to assist the practitioner caring for adults and children with chronic kidney disease (CKD), those on chronic dialysis therapy, or individuals with a kidney transplant. This review highlights key aspects of the 2017 CKD-MBD Guideline Update, with an emphasis on the rationale for the changes made to the original guideline document. Topic areas encompassing updated recommendations include diagnosis of bone abnormalities in CKD-mineral and bone disorder (MBD), treatment of CKD-MBD by targeting phosphate lowering and calcium maintenance, treatment of abnormalities in parathyroid hormone in CKD-MBD, treatment of bone abnormalities by antiresorptives and other osteoporosis therapies, and evaluation and treatment of kidney transplant bone disease.

Sarcopenia, Relative Sarcopenia and Excess Adiposity in Chronic Kidney Disease

“…Kidney Disease Improving Global Outcomes (KDIGO) guidelines now recommend the use of DXA in CKD to assess bone mineral density, so it is possible full body DXA could also be performed in the future including T and Z scores of ALMI adjusted for FMI on clinical reports. [35] Dependent on how these measures relate to clinical outcomes in future studies, this information could aid clinicians in identifying those patients at highest risk for frailty, fracture, disability and death.…”

Secondary hyperparathyroidism in patient with type 2 diabetes and stages 3–4 chronic kidney disease

“…У пациентов с ХБП С3а-5D и признаками минераль-но-костных нарушений и/или факторами риска остео-пороза (в данном клиническом случае возраст, наличие сахарного диабета), в рекомендациях KDIGO от 2017 г. предлагается исследовать минеральную плотность костной ткани для оценки риска переломов и реше-ния вопроса о целесообразности проведения лечения (2Б) [18].…”

“…улучшение показателей нефропатии -альбумин/кре-атинин в утренней порции мочи 108 мг/г, скорость клубочковой фильтрации 34 мл/мин/1,73 м 2 ; 3. сохранение вторичного гиперпаратиреоза на фоне нормализации показателей фосфора и скорректиро-ванного на альбумин кальция крови (ПТГ 214 пг/мл); 4. учитывая наличие дефицита витамина D и вторично-го гиперпаратиреоза, к терапии был подключен коле-кальциферол 50 000 МЕ в неделю У пациентов с ХБП С3а-5 в рекомендациях KDIGO от 2017 г. предлагается дефицит и недостаточность ви-тамина D корректировать как в общей популяции (2С). У этой когорты пациентов предлагается регулярно не ис-пользовать кальцитриол и аналоги витамина D (2С), а их использование оставлять как резервную терапию для коррекции гиперпаратиреоза тяжелого и прогрес-сивного течения [18].…”

Challenging look at therapeutic trend of chronic kidney disease–mineral bone disorder in children

“…These therapeutic strategies for management of hyperphosphatemia are based on their values and changes in calcium and phosphorus homeostasis based on the age of children. According to recent 2017 KDIGO CKD-MBD guideline, children with CKD grade 3A (GFR; 45-59 mL/ min/1.73 m 2 ) to grade 5D (GFR <15 mL/min/1.73 m 2 on dialysis), should be treated with phosphate-lowering agents according to serum calcium levels (1,2). In this group, we have also a therapeutic strategy with noncalcium based phosphate-binding compounds, including sevelamer hydrochloride (Renagel ® ) and sevelame carbonate((Renvela ® ).…”