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Therapeutic interventions for chronic kidney disease-mineral and bone disorders: focus on mortality

Geoffrey A Block1

  • 1Denver Nephrologists PC, Denver, Colorado 80230, USA. gablock@denverneph.net

Current Opinion in Nephrology and Hypertension
|April 27, 2011
PubMed

Insights

High phosphorus and FGF-23 levels in chronic kidney disease-mineral and bone disorder (CKD-MBD) correlate with mortality. Interventions targeting CKD-MBD may improve survival, but require randomized trials for confirmation.

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiovascular Medicine

Background:

  • Chronic kidney disease-mineral and bone disorder (CKD-MBD) involves complex bone and cardiovascular abnormalities.
  • Current research often focuses on surrogate outcomes rather than mortality.
  • Understanding CKD-MBD's impact on patient survival is critical.

Purpose of the Study:

  • To review recent literature on interventions for CKD-MBD, focusing on mortality as the primary clinical outcome.
  • To assess the link between mineral metabolism abnormalities and mortality in CKD patients.
  • To evaluate the evidence for interventions impacting CKD-MBD and patient survival.

Main Methods:

  • Literature review of recent studies on CKD-MBD interventions.
  • Analysis of studies reporting on mortality as a clinical outcome.
  • Examination of interventions affecting phosphorus, FGF-23, calcium, and parathyroid hormone levels.

Main Results:

  • Elevated serum phosphorus and FGF-23 are linked to increased mortality across all CKD stages.
  • Interventions targeting dietary phosphorus and mineral levels support the hypothesis of a direct link to mortality.
  • Limited evidence exists from placebo-controlled randomized trials, except for altered dialysis prescriptions.

Conclusions:

  • Accumulating observational data suggest therapeutic interventions improve survival in CKD patients with CKD-MBD.
  • Interventions include phosphate binders, calcimimetics, and dietary/dialysis modifications.
  • Randomized clinical trials are necessary to confirm if CKD-MBD interventions improve hard clinical outcomes.
Abstract

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