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Therapeutic interventions for chronic kidney disease-mineral and bone disorders: focus on mortality.
Curr Opin Nephrol Hypertens. 2011 Jul; 20(4):376-81.CO

Abstract

PURPOSE OF REVIEW

Chronic kidney disease-mineral and bone disorder (CKD-MBD) encompasses a broad spectrum of abnormalities related to bone and cardiovascular health. Many reports related to therapeutic interventions specifically aimed at these disorders describe an effect only on surrogate outcomes. This review will focus on recent literature pertaining to interventions directed at CKD-MBDs that emphasize the clinical outcome of mortality.

RECENT FINDINGS

Higher levels of serum phosphorus (including those within the normal range) and its regulatory hormone, fibroblast growth factor 23 (FGF-23), are associated with increased mortality in patients with all stages of CKD. Reports investigating specific interventions that affect dietary intake of phosphorus, as well as serum levels of phosphorus, FGF-23, calcium, and parathyroid hormone have recently been published which support the hypothesis that abnormal mineral metabolism is directly linked to increased mortality. Unfortunately, with the exception of altered dialysis prescription, no intervention has been subject to the scrutiny of placebo-controlled randomized clinical trials.

SUMMARY

Observational evidence continues to accumulate relating specific therapeutic interventions to improved survival in patients with kidney disease including phosphate binders, calcimimetics, and altered dietary and dialysis prescription patterns. It is time for randomized clinical trials to definitively establish whether or not interventions directed at CKD-MBD effect improvement in hard clinical outcomes in patients with kidney disease.

Authors+Show Affiliations

Denver Nephrologists PC, Denver, Colorado 80230, USA. gablock@denverneph.net

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

21519253

Citation

Block, Geoffrey A.. "Therapeutic Interventions for Chronic Kidney Disease-mineral and Bone Disorders: Focus On Mortality." Current Opinion in Nephrology and Hypertension, vol. 20, no. 4, 2011, pp. 376-81.
Block GA. Therapeutic interventions for chronic kidney disease-mineral and bone disorders: focus on mortality. Curr Opin Nephrol Hypertens. 2011;20(4):376-81.
Block, G. A. (2011). Therapeutic interventions for chronic kidney disease-mineral and bone disorders: focus on mortality. Current Opinion in Nephrology and Hypertension, 20(4), 376-81. https://doi.org/10.1097/MNH.0b013e328346f93f
Block GA. Therapeutic Interventions for Chronic Kidney Disease-mineral and Bone Disorders: Focus On Mortality. Curr Opin Nephrol Hypertens. 2011;20(4):376-81. PubMed PMID: 21519253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapeutic interventions for chronic kidney disease-mineral and bone disorders: focus on mortality. A1 - Block,Geoffrey A, PY - 2011/4/27/entrez PY - 2011/4/27/pubmed PY - 2011/10/1/medline SP - 376 EP - 81 JF - Current opinion in nephrology and hypertension JO - Curr Opin Nephrol Hypertens VL - 20 IS - 4 N2 - PURPOSE OF REVIEW: Chronic kidney disease-mineral and bone disorder (CKD-MBD) encompasses a broad spectrum of abnormalities related to bone and cardiovascular health. Many reports related to therapeutic interventions specifically aimed at these disorders describe an effect only on surrogate outcomes. This review will focus on recent literature pertaining to interventions directed at CKD-MBDs that emphasize the clinical outcome of mortality. RECENT FINDINGS: Higher levels of serum phosphorus (including those within the normal range) and its regulatory hormone, fibroblast growth factor 23 (FGF-23), are associated with increased mortality in patients with all stages of CKD. Reports investigating specific interventions that affect dietary intake of phosphorus, as well as serum levels of phosphorus, FGF-23, calcium, and parathyroid hormone have recently been published which support the hypothesis that abnormal mineral metabolism is directly linked to increased mortality. Unfortunately, with the exception of altered dialysis prescription, no intervention has been subject to the scrutiny of placebo-controlled randomized clinical trials. SUMMARY: Observational evidence continues to accumulate relating specific therapeutic interventions to improved survival in patients with kidney disease including phosphate binders, calcimimetics, and altered dietary and dialysis prescription patterns. It is time for randomized clinical trials to definitively establish whether or not interventions directed at CKD-MBD effect improvement in hard clinical outcomes in patients with kidney disease. SN - 1473-6543 UR - https://www.unboundmedicine.com/medline/citation/21519253/Therapeutic_interventions_for_chronic_kidney_disease_mineral_and_bone_disorders:_focus_on_mortality_ L2 - https://doi.org/10.1097/MNH.0b013e328346f93f DB - PRIME DP - Unbound Medicine ER -