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Cardiovascular risk in chronic kidney disease (CKD): the CKD-mineral bone disorder (CKD-MBD).
Pediatr Nephrol. 2010 Apr; 25(4):769-78.PN

Abstract

Recent advances in our understanding of the excess mortality of chronic kidney disease (CKD) due to cardiovascular complications, obtained through observational studies, demonstrate that vascular calcification and hyperphosphatemia are major cardiovascular risk factors. Mechanistic studies demonstrate that these two risk factors are related and that hyperphosphatemia directly stimulates vascular calcification. The role of hyperphosphatemia in stimulating vascular calcification in CKD is associated with a block to the skeletal reservoir function in phosphate balance due to excess bone resorption. This has led to the realization that renal osteodystrophy is linked to vascular calcification by disordered mineral homeostasis (phosphate) and that a multiorgan system fails in CKD, leading to cardiovascular mortality. In children with renal disease, the multiorgan system fails, just as in adults, but the outcomes have been less well studied, and perceptions of differences from adults are possibly incorrect. Vascular calcification and cardiovascular mortality are less prevalent among pediatric patients, but they are present. However, CKD-induced vascular disease causes stiffness of the arterial tree causing, in turn, systolic hypertension and left ventricular hypertrophy as early manifestations of the same pathology in the adult. Because of the role of the skeleton in these outcomes, renal osteodystrophy has been renamed as the CKD mineral bone disorder (CKD-MBD). This review, which focuses on the pediatric patient population, describes our current state of knowledge with regards to the pathophysiology of the CKD-MBD, including the new discoveries related to early stages of CKD. As a new necessity, cardiovascular function issues are incorporated into the CKD-MBD, and new advances in our knowledge of this critical component of the disorder will lead to improved outcomes in CKD.

Authors+Show Affiliations

Division of Pediatric Nephrology, Washington University, St. Louis, MO, USA. hruska_k@kids.wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

19898875

Citation

Hruska, Keith A., et al. "Cardiovascular Risk in Chronic Kidney Disease (CKD): the CKD-mineral Bone Disorder (CKD-MBD)." Pediatric Nephrology (Berlin, Germany), vol. 25, no. 4, 2010, pp. 769-78.
Hruska KA, Choi ET, Memon I, et al. Cardiovascular risk in chronic kidney disease (CKD): the CKD-mineral bone disorder (CKD-MBD). Pediatr Nephrol. 2010;25(4):769-78.
Hruska, K. A., Choi, E. T., Memon, I., Davis, T. K., & Mathew, S. (2010). Cardiovascular risk in chronic kidney disease (CKD): the CKD-mineral bone disorder (CKD-MBD). Pediatric Nephrology (Berlin, Germany), 25(4), 769-78. https://doi.org/10.1007/s00467-009-1337-0
Hruska KA, et al. Cardiovascular Risk in Chronic Kidney Disease (CKD): the CKD-mineral Bone Disorder (CKD-MBD). Pediatr Nephrol. 2010;25(4):769-78. PubMed PMID: 19898875.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiovascular risk in chronic kidney disease (CKD): the CKD-mineral bone disorder (CKD-MBD). AU - Hruska,Keith A, AU - Choi,Eric T, AU - Memon,Imran, AU - Davis,T Keefe, AU - Mathew,Suresh, Y1 - 2009/11/07/ PY - 2009/07/01/received PY - 2009/09/17/accepted PY - 2009/09/14/revised PY - 2009/11/10/entrez PY - 2009/11/10/pubmed PY - 2010/6/3/medline SP - 769 EP - 78 JF - Pediatric nephrology (Berlin, Germany) JO - Pediatr Nephrol VL - 25 IS - 4 N2 - Recent advances in our understanding of the excess mortality of chronic kidney disease (CKD) due to cardiovascular complications, obtained through observational studies, demonstrate that vascular calcification and hyperphosphatemia are major cardiovascular risk factors. Mechanistic studies demonstrate that these two risk factors are related and that hyperphosphatemia directly stimulates vascular calcification. The role of hyperphosphatemia in stimulating vascular calcification in CKD is associated with a block to the skeletal reservoir function in phosphate balance due to excess bone resorption. This has led to the realization that renal osteodystrophy is linked to vascular calcification by disordered mineral homeostasis (phosphate) and that a multiorgan system fails in CKD, leading to cardiovascular mortality. In children with renal disease, the multiorgan system fails, just as in adults, but the outcomes have been less well studied, and perceptions of differences from adults are possibly incorrect. Vascular calcification and cardiovascular mortality are less prevalent among pediatric patients, but they are present. However, CKD-induced vascular disease causes stiffness of the arterial tree causing, in turn, systolic hypertension and left ventricular hypertrophy as early manifestations of the same pathology in the adult. Because of the role of the skeleton in these outcomes, renal osteodystrophy has been renamed as the CKD mineral bone disorder (CKD-MBD). This review, which focuses on the pediatric patient population, describes our current state of knowledge with regards to the pathophysiology of the CKD-MBD, including the new discoveries related to early stages of CKD. As a new necessity, cardiovascular function issues are incorporated into the CKD-MBD, and new advances in our knowledge of this critical component of the disorder will lead to improved outcomes in CKD. SN - 1432-198X UR - https://www.unboundmedicine.com/medline/citation/19898875/Cardiovascular_risk_in_chronic_kidney_disease__CKD_:_the_CKD_mineral_bone_disorder__CKD_MBD__ L2 - https://dx.doi.org/10.1007/s00467-009-1337-0 DB - PRIME DP - Unbound Medicine ER -