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The demise of calcium-based phosphate binders-is this appropriate for children?
Lesley Rees1, Rukshana Shroff2
1Paediatric Nephrology, Great Ormond Street Hospital for Children, Great Ormond St, London, WC1N 3JH, UK. l.rees@ucl.ac.uk.
Insights
Optimal control of mineral and bone disorder (MBD) in children with chronic kidney disease (CKD) is vital for bone health and cardiovascular well-being. This review focuses on the critical role of calcium in managing CKD-MBD in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Mineral and Bone Disorder (MBD)
- Chronic Kidney Disease (CKD)
Background:
- Mineral and Bone Disorder (MBD) management is crucial in pediatric chronic kidney disease (CKD) for skeletal health, growth, and cardiovascular outcomes.
- The pediatric skeleton is highly susceptible to CKD effects, leading to bone pain, fractures, and deformities, particularly in children on dialysis.
- Defective bone mineralization in CKD is linked to ectopic calcification, increasing morbidity and mortality.
Purpose of the Study:
- To review the critical role of calcium in the management of mineral and bone disorder (MBD) in children with chronic kidney disease (CKD).
- To highlight the challenges in managing mineral dysregulation despite existing guidelines.
- To discuss the impact of serum calcium levels on bone mineralization and arterial calcification in pediatric CKD.
Main Methods:
- Literature review of clinical and experimental studies.
- Analysis of the association between serum calcium levels and bone health in pediatric CKD.
- Examination of the link between serum calcium and ectopic calcification in children with CKD.
Main Results:
- Despite guidelines, many pediatric CKD patients exhibit abnormal calcium, phosphate, or parathyroid hormone levels.
- Low serum calcium is associated with poor bone mineralization in CKD.
- High serum calcium levels can lead to arterial calcification, even in children.
Conclusions:
- Calcium plays a pivotal role in pediatric chronic kidney disease-mineral and bone disorder (CKD-MBD).
- Careful management of serum calcium is essential to prevent skeletal complications and arterial calcification.
- Further research and clinical strategies are needed to optimize calcium balance in pediatric CKD.
Abstract:
In children with chronic kidney disease (CKD) optimal control of mineral and bone disorder (MBD) is essential not only for the prevention of debilitating skeletal complications and for achieving adequate growth, but also for preserving long-term cardiovascular health. The growing skeleton is particularly vulnerable to the effects of CKD, and bone pain, fractures and deformities are common in children on dialysis. Defective bone mineralisation has been linked with ectopic calcification, which in turn leads to significant morbidity and mortality. Despite national and international guidelines for the management of CKD-MBD, the management of mineral dysregulation in CKD can be extremely challenging, and a significant proportion of patients have calcium, phosphate or parathyroid hormone levels outside the normal ranges. Clinical and experimental studies have shown that, in the setting of CKD, low serum calcium levels are associated with poor bone mineralisation, whereas high serum calcium levels can lead to arterial calcification, even in children. The role of calcium in CKD-MBD is the focus of this review.
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