Calcium, Phosphate, and Renal Osteodystrophy: CKD: Mineral and Bone Disorder

Abstract

Chronic kidney disease (CKD) and peritoneal dialysis dependent end-stage kidney disease are almost invariably associated with deranged mineral and bone metabolism, which is evident either as abnormal calcium, phosphate, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23) and vitamin D metabolism; abnormal bone turnover, mineralization, volume, growth, and strength; or the presence of extraskeletal calcification. These abnormalities often appear together in combination with varying degrees of involvement and are associated with high mortality rates, primarily from cardiovascular complications. Since 2006 following the recommendation from KDIGO (Kidney Disease: Improving Global Outcomes) disorders of divalent ion metabolism and resulting renal osteodystrophy have been referred to as chronic kidney disease- mineral and bone disorder (CKD-MBD), a term that encompasses the wider spectrum of disorders associated with this metabolic state. This chapter attempts to outline the manifestations ofmineral and bone disorder in the context of CKD with a focus on PD dependent end-stage kidney disease including the recent advances and consensus guidance on its management.