[Guideline for the management of chronic kidney disease-related mineral and bone disorders (CKD-MBD)]

Abstract

Abnormalities of mineral and bone metabolism in patients with chronic kidney disease (CKD) have traditionally been assessed and managed in terms of renal osteodystrophy (ROD). However, it has been demonstrated that abnormal mineral and bone metabolism in CKD not only produces bone lesions, but also influences the prognosis by causing ectopic calcification throughout the body including the blood vessels over the long term. Consequently, it has been proposed that the conventional term ROD should be used for bone lesions only, and a new concept of CKD-related mineral and bone disorders should be introduced. In 2003, the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines were released. In Japan, guidelines for the treatment of secondary hyperparathyroidism in patients on dialysis were reported in 2006. This guidelines were drafted on the basis that PTH should be controlled with the serum phosphorus and serum calcium levels remaining under optimal control. Under these circumstances, the regulation of PTH is limited by the range of target values for serum phosphorus and calcium. P : 3.5-6.0 mg/dL, Ca : 8.4-10.0 mg/dL, Intact PTH : 60-180 pg/mL, Indication of PTx or PEIT : intact PTH>500 pg/mL.