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[CKD-MBD in Peritoneal Dialysis].

Anna Rachele Rocca1, Tania Gnerre Musto1, Sandro Mazzaferro1

  • 1Dipartimento di Scienze Cardiovascolari Respiratorie Nefrologiche Anestetiche e Geriatriche. Sapienza Università di Roma.

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
|March 28, 2018
PubMed
Summary
This summary is machine-generated.

Chronic kidney disease-mineral and bone disorder (CKD-MBD) targets remain unmet in dialysis patients. Hyperphosphatemia is a key mortality predictor, highlighting the need for improved phosphorus and calcium management in hemodialysis and peritoneal dialysis.

Keywords:
Adynamic Bone DiseaseCKD-MBDcalciumperitoneal dialysisphosphorus

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Area of Science:

  • Nephrology
  • Endocrinology
  • Bone Metabolism

Background:

  • Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a complex systemic complication of chronic kidney disease (CKD).
  • Despite established biochemical targets, CKD-MBD management remains challenging in hemodialysis (HD) and peritoneal dialysis (PD) patients.
  • Hyperphosphatemia is a significant predictor of cardiovascular and all-cause mortality in these patient populations.

Purpose of the Study:

  • To review the challenges and current understanding of mineral and bone metabolism in dialysis patients.
  • To highlight the importance of phosphorus and calcium control in improving patient outcomes.
  • To explore the bone-cardiac axis and bone quality differences between HD and PD patients.

Main Methods:

  • Review of current literature on CKD-MBD in hemodialysis and peritoneal dialysis.
  • Analysis of phosphorus and calcium clearance mechanisms in PD (diffusion, convection, ultrafiltration).
  • Discussion of the role of residual renal function and bone-derived substances.

Main Results:

  • Phosphorus removal in PD is time-dependent and influenced by dialysis modality and membrane characteristics.
  • Calcium balance in PD is affected by dialysate calcium levels and ultrafiltration, with positive balance potentially leading to Adynamic Bone Disease.
  • While bone histomorphometry shows fewer differences between HD and PD patients than previously thought, PD patients report fewer fractures, possibly due to better bone quality.

Conclusions:

  • Achieving therapeutic targets for CKD-MBD remains a significant clinical challenge in dialysis patients.
  • Effective management of hyperphosphatemia is crucial for reducing mortality risk.
  • Further research into bone quality and the bone-cardiac axis may offer new therapeutic strategies for CKD-MBD.