Bone and Chronic Kidney Disease

Area of Science:

• Nephrology and Endocrinology

Background:

• Chronic kidney disease (CKD) is strongly associated with mineral and bone disorders (CKD-MBD), impacting calcium and phosphate metabolism.
• CKD-MBD contributes to renal osteodystrophy, vascular calcifications, and an elevated risk of cardiovascular events and fractures.

Approach:

• This review synthesizes the pathophysiology, histologic features, and radiologic signs of CKD-MBD.
• It examines osteoporosis assessment, considering both general and CKD-specific risk factors.
• Current therapeutic strategies for mineral disorders and osteoporosis in CKD are discussed.

Key Points:

• CKD-induced bone lesions include renal osteodystrophy with variable bone remodeling and impaired mineralization.
• Vascular calcifications and bone disease in CKD-MBD significantly elevate morbidity and mortality risks.
• Osteoporosis screening in CKD patients requires evaluation of disease duration, severity, and dialysis history.

Conclusions:

• Effective management of CKD-MBD involves phosphate-lowering drugs, vitamin D analogs, and calcium-sensing receptor agonists.
• While osteoporosis treatment is standard in early CKD stages, its efficacy and safety in severe CKD require further investigation due to scarce evidence.