Mineral and bone disorders in children with chronic kidney disease

Abstract

Childhood and adolescence are the crucial times for developing a healthy skeletal and vascular system; alterations in bone modeling/remodeling or vascular biology in youth carry consequences that severely impact the quality of life as well as life span. In childhood, chronic kidney disease (CKD) causes disordered regulation of mineral metabolism with subsequent alterations in bone modeling, remodeling, and growth. These alterations occur early in the course of CKD and are accompanied by the development of cardiovascular calcifications. Since growth failure and short stature are clinically apparent and concerning to patients, families, and physicians alike, optimization of growth and final adult height has been a focus of CKD management in children for decades. However, cardiovascular disease is the leading cause of mortality in both adults and children with kidney disease and abnormal mineral metabolism, bone disease and its therapies are closely linked to cardiovascular pathology. Together, these alterations are termed “CKD Mineral and Bone Disorder” (“CKD-MBD”) [1].