Chronic kidney disease-mineral and bone disorder: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
A 2023 KDIGO Controversies Conference concluded that the 2017 CKD-MBD guideline recommendations remain largely consistent with current evidence, but proposed reframing future guidance around two clinical syndromes and individualized care.
Background
KDIGO published its CKD-MBD guideline update in 2017, addressing biochemical abnormalities in mineral metabolism, bone disease, and vascular calcification. Since then, new evidence has emerged on disordered mineral metabolism, bone quality and turnover, vascular calcification, vitamin D, and parathyroid hormone regulation. In October 2023, KDIGO convened a Controversies Conference titled CKD-MBD: Progress and Knowledge Gaps Toward Personalizing Care.
Key recommendations
Participants concluded that the 2017 guideline recommendations remained largely consistent with available evidence. However, they suggested that the 2017 framework of three sections may no longer best reflect current evidence. Instead, future guideline efforts could organize around two clinical syndromes in adults: CKD-associated osteoporosis, encompassing increased fracture risk, and CKD-associated cardiovascular disease, including vascular calcification and structural abnormalities such as valvular calcification and left ventricular hypertrophy.
Clinical implications
The conference emphasized that the complexity of bone and cardiovascular manifestations of CKD-MBD necessitates personalized approaches to management. Conceptualizing care around osteoporosis-related fracture risk and cardiovascular calcification may better guide individualized diagnosis and treatment than the prior structure.
Category
KDIGO
Source
Kidney Int
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