Phosphorus and other aspects of CKD-MBD in the conservative management of chronic kidney disease

Panminerva Med. 2017 Jun;59(2):124-132. doi: 10.23736/S0031-0808.17.03302-X.

Abstract

As the prevalence of chronic kidney disease (CKD) increases and the population ages, there is an imperative to offer cost effective and patient specific therapeutic options for the management of advanced CKD. In cases where there is a desire to avoid or delay renal replacement therapy, conservative options need to be defined and strategies for delaying the need for renal replacement therapy should be offered. CKD-mineral bone disorders (MBD) refers to the constellation of disturbances in abnormal bone and soft tissue calcification along with abnormalities, in phosphorus, calcium, parathyroid hormone, vitamin D, and FGF-23. CKD-MBD is associated with morbidity and mortality in dialysis patients. Addressing CKD-MBD necessitated understanding phosphorus handling in the intestine and kidney and the ordered process of vascular calcification and uremic osteodystrophy. Decreasing dietary phosphorus intake and absorption is the mainstay of conservative management of CKD-MBD; pharmacologic therapy with binders, vitamin D analogues, and niacin may also be indicated. FGF-23 levels, parathyroid hormone levels, tubular reabsorption of phosphorus, and 24 hour urinary phosphorus can be tracked to trigger and evaluate these interventions. Further research is required to generate an ordered multifaceted approach to CKD-MBD.

Publication types

  • Review

MeSH terms

  • Animals
  • Bone Diseases / economics
  • Bone Diseases / therapy
  • Calcium / blood
  • Conservative Treatment*
  • Cost-Benefit Analysis
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / metabolism
  • Humans
  • Parathyroid Hormone / metabolism
  • Phosphates / blood
  • Phosphorus / therapeutic use*
  • Phosphorus / urine
  • Renal Dialysis
  • Renal Insufficiency, Chronic / economics
  • Renal Insufficiency, Chronic / therapy*
  • Renal Replacement Therapy*
  • Treatment Outcome
  • Vascular Calcification
  • Vitamin D / analogs & derivatives

Substances

  • FGF23 protein, human
  • Parathyroid Hormone
  • Phosphates
  • Vitamin D
  • Phosphorus
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
  • Calcium