Mineral and Bone Disorder in CKD

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Background

The term Mineral and Bone Disorder (MBD) associated with chronic kidney disease (CKD–MBD) has been proposed by the Kidney Disease Improving Global Outcomes (KDIGO) to define the broad clinical syndrome that develops as a systemic bone disorder due to mineral, skeletal and vascular abnormalities that occur in association with CKD. CKD-MBD may manifest by one or a combination of the following: (1) abnormalities of calcium, phosphorous, PTH, or vitamin D metabolites; (2) abnormalities in bone histology, linear growth, or strength; or (3) vascular or other soft-tissue calcification. Its pathogenesis is multifactorial, associated with the combined contribution of hyperposphataemia, high levels of the phosphaturic hormone fibroblast growth factor-23 (FGF-23), hypocalcaemia, vitamin D deficiency and secondary hyperparathyroidism.

Since childhood and adolescence are crucial periods for the development of a healthy skeletal and cardiovascular system, CKD–MBD is particularly challenging in this age group. Moreover, a growing body of evidence demonstrates that cardiovascular disease is a major cause of morbidity and mortality not only in adults but also in pediatric patients with CKD, and that therapies designed to treat the skeletal consequences of CKD affect the progression of vascular pathology. However, further studies are required to determine whether treatment of CKD-MBD results in improvement in hard clinical outcomes including death and cardiovascular events in patients with CKD. In this context, the optimal target concentration ranges of PTH and mineral electrolytes allowing appropriate bone turnover and avoiding extraosseous calcifications are a focus of attention and it has been accepted that phosphate, calcium and PTH levels should be considered together when making management decisions. In detail, in children with CKD 3-5 stages is recommended : a) to maintain serum calcium in the age-appropriate normal range b) to base the choice of phosphate-binders treatment on serum calcium levels and c) to institute Vitamin D analogues or the calcimimetic cinacalcet once PTH levels rise.

In this Research Topic entitled “Mineral and Bone Disorder in CKD” we encourage manuscripts in the format of original research papers, systematic reviews, mini reviews, policy and practice reviews, hypothesis and theory, perspectives, clinical trials, case reports and all other types accepted by the journal.

We would like to focus on:
- Epidemiology of CKD–MBD
- New insights in pathogenesis of CKD–MBD
- Clinical manifestation of CKD–MBD
- Assessment of bone health in CKD–MBD
- Optimizing bone health in CKD–MBD
- Assessment of vascular health in CKD–MBD
- Impact of CKD–MBD in growth
- Impact of CKD–MBD in mortality
- Impact of CKD–MBD in cardiovascular risk
- Severe cases of CKD–MBD
- Optimizing treatment of CKD–MBD
- New insights in treatment of CKD–MBD

Keywords: Mineral and bone disorder, chronic kidney disease, secondary hyperparathyroidism, cardiovascular risk, children, FGF-23

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