Chronic Kidney Disease - Mineral and Bone Disorder (CKD-MBD)

Abstract

Chronic kidney disease mineral and bone disorder (CKD-MBD) is a systemic disorder that encompasses alterations in mineral homeostasis, bone turnover, mineralization, volume and strength, linear growth and strength, and cardiovascular disease. CKD-MBD in childhood may lead to significant bone pain, deformities, and fractures that hinder the daily activities and quality of life of children with advanced CKD; these sequelae persist into adulthood whereas many as 18% of this population reported disabilities resulting from their bone disease. Children with CKD, especially those on dialysis, have a greatly increased risk of cardiovascular (CV) morbidity and mortality; vascular calcifications are present in even children and young adults with end-stage kidney disease (ESKD). Management of CKD-MBD requires attention to long-term skeletal and cardiovascular health. Clinical evaluation of height, growth velocity, blood pressure and a musculoskeletal examination, focusing on bone pain, deformities, and fractures, should be performed routinely in children with CKD; dietary calcium (Ca) and phosphate (P) intake should also be assessed at regular intervals. P-binders and vitamin D analogs should be used to treat secondary hyperparathyroidism in children with advanced CKD. Age-, gender-, and CKD stage- appropriate values of Ca, P, alkaline phosphatase, and PTH should be used to guide therapy.