Management of chronic kidney disease-mineral and bone disorder: Korean working group recommendations

Abstract

For Korean dialysis patients, chronic kidney disease-mineral bone disorder is a serious burden because of cardiovascular calcification and mortality. However, recent epidemiologic data have demonstrated that many patients undergoing maintenance hemodialysis are out of the target ranges of serum calcium, phosphorus, and intact parathyroid hormone. Thus, we felt the necessity for the development of practical recommendations to treat abnormal serum phosphorus, calcium, and iPTH in dialysis patients. In this paper, we briefly comment on the measurement of serum calcium, phosphorus, iPTH, dialysate calcium concentration, dietary phosphorus restriction, use of phosphate binders, and medical and surgical options to correct secondary hyperparathyroidism. In particular, for the optimal management of secondary hyperparathyroidism, we suggest a simplified medication adjustment according to certain ranges of serum phosphorus and calcium. Large-scale, well-designed clinical studies are required to support our strategies to control chronic kidney disease-mineral bone disorder in this country. Based on such data, our practice guidelines could be established and better long-term outcomes should be anticipated in our dialysis patients.

Keywords: Calcium; Dialysis; Phosphorus; Secondary hyperparathyroidism.

Figure 1

Summary of the treatment strategy for control of secondary hyperparathyroidism according to the level of serum calcium and phosphorus. ¹NCPB, non–calcium-based phosphate binder, is reimbursed for P ≥ 5.5 mg/dL, and Ca-P ≥ 55 mg²/dL² (according to the Korean National Health Insurance Standards, as of July 2014).