78. Treatment Of Chronic Kidney Disease Mineral Bone Disorder (CKD-MBD)

  1. Clifford J. Rosen MD
  1. Hala M. Alshayeb and
  2. L. Darryl Quarles

Published Online: 19 JUL 2013

DOI: 10.1002/9781118453926.ch78

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition

Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition

How to Cite

Alshayeb, H. M. and Quarles, L. D. (2013) Treatment Of Chronic Kidney Disease Mineral Bone Disorder (CKD-MBD), in Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition (ed C. J. Rosen), John Wiley & Sons, Inc., Ames, USA. doi: 10.1002/9781118453926.ch78

Publication History

  1. Published Online: 19 JUL 2013

ISBN Information

Print ISBN: 9781118453889

Online ISBN: 9781118453926

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Keywords:

  • bone biopsies;
  • chronic kidney disease (CKD);
  • fibroblast growth factor 23 (FGF23);
  • mineral bone disorder (MBD)

Summary

Loss of glomerular filtration and other renal functions in chronic kidney disease leads to complex abnormalities of mineral homeostasis, referred to as mineral and bone disorder, all causing mortality. This chapter discusses the pathophysiology, pathogenesis, diagnosis, and treatment of chronic kidney disease mineral bone disorder (CKD-MBD). Three hormones [PTH, fibroblast growth factor 23 (FGF23), and 1,25(OH)2D] and four organ systems [parathyroid gland (PTG), bone, small intestines, and kidney] are involved in regulation mineral homeostasis. Initial secretion of FGF23 by the bone triggered by unknown stimuli is the inciting event leading to secondary hyperparathyroidism in CKD. Currently, other than bone biopsies, there is no diagnostic test that identifies the different subtypes of bone diseases in CKD. Treatment considerations depend on the stage of CKD, the mechanism of action of the various therapeutic agents, potential toxicities associated with various treatments, and cost/reimbursement of the various therapies.