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Last Updated 10/22/17
 

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Unless closely monitored, renal bone disease (renal osteodystrophy) is a problem that will be experienced by most people suffering from end stage renal disease (ESRD). Renal bone disease is a complex issue and involves many more factors than can be listed in this limited space. Only the very basics are outlined here.

First, the kidneys are involved in the synthesis of vitamin D, which is the most essential factor regulating intestinal absorption of calcium in humans. When the kidneys fail and less vitamin D is created, the amount of calcium absorbed by the intestines is reduced. Calcium is most essential substance for bone maintenance and health. Next, calcium and phosphorus levels in the blood (which are normally regulated by the kidneys) are dependent upon each other. Therefore, when the kidneys fail and the phosphorus level in the blood goes up, the (free) calcium level in the blood decreases. In response to these two factors that lower serum calcium, the body then increases the parathyroid hormone (PTH) level in the blood.  PTH causes calcium to be released from the bones in order to increase the serum calcium level.  Left untreated, an ESRD patient will have bones that are depleted of calcium, brittle, and likely to fracture.

Treatment and prevention of renal bone disease usually include the use of phosphate binders and vitamin D analogs (to reduce PTH levels).  In the past, treatment frequently included the removal of the parathyroid glands.

Normal serum calcium is 8.5-10.8 mg/dL.

Normal serum phosphorus for dialysis patients is 3.5 to 5.5 mg/dl High phosphorus levels also cause itchy skin.

It is recommended that ESRD patients maintain a calcium phosphorous product that is below 70.

Warning:  Changes should never be made in a patient's treatment or care based solely on the information found here.  Every patient has unique healthcare concerns and considerations and all these factors must all be taken into account before any changes can be safely made.  All medical and therapeutic decisions must come from a qualified health care provider.  Read RenalWEB's Legal Disclaimer before proceeding.


  NEWS AND LATEST INFORMATION
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Circulating Markers of Bone Turnover - Free, Open Access article from Journal of Nephrology. - October 2017

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Aldosterone Antagonist Therapy and Its Relationship with Inflammation, Fibrosis, Thrombosis, Mineral Bone Disorder and Cardiovascular Complications in Peritoneal Dialysis (PD) Patients - Free, Open Access article from International Urology and Nephrology. - October 2017

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The Use of Cinacalcet Hinders the Diagnosis of Parathyroid Carcinoma in a Chronic Dialysis Patient: a Case Report - Free, Open Access article from BMC Nephrology. - October 18, 2017

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CKD-MBD KDIGO Guidelines: How Difficult Is Reaching the 'Target'? - Free, Full-Text, Advance Articles from Clinical Kidney Journal. - October 12, 2017

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Parathyroid Nodular Hyperplasia and Responsiveness to Drug Therapy in Renal Secondary Hyperparathyroidism: An Open Question - Early View abstract from Therapeutic Apheresis and Dialysis. - October 5, 2017

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CKD Patients Frequently Re-hospitalized After Parathyroidectomy - Article from Renal & Urology News. - October 3, 2017

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Efficacy and Safety of Sucroferric Oxyhydroxide and Calcium Carbonate in Hemodialysis Patients - 34-page pdf - Open Access PDF Articles in Press from Kidney International Reports. - October 2, 2017

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Etelcalcetide Shows Efficacy, Safety Over 52 Weeks - Article from Renal & Urology News. - October 2, 2017

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Parathyroidectomy — A Last Resort for Hyperparathyroidism in Dialysis Patients - Free, Full-Text Editorial from Seminars In Dialysis. - September/October 2017

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A Pilot Study of OkKidney, A Phosphate Counting Application in Patients on Peritoneal Dialysis - PDI in Press Abstract. - September 2017

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Analysis of Mandibular Changes Using Panoramic-based Indices in Patients with Chronic Renal Failure - Advance Online abstract from the International Journal of Artificial Organs. - September 29, 2017

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Serum Phosphorus Levels and Fracture Following Renal Transplantation - Article from Clinical Endocrinology - Article from Medscape Nephrology (registration required, but free). - September 27, 2017

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Fractures in Patients with CKD — Diagnosis, Treatment, and Prevention: a Review by Members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation - Article in Press abstract from Kidney International. - September 27, 2017

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Expert Panel: Calcifediol Possibly a Better Option for SHPT - Tweet from Daniel Coyne - Article from Renal & Urology News. - September 26, 2017

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Free, Open Access, First Online Articles from Journal of Nephrology - September 23, 2017

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Achievement of Kidney Disease: Improving Global Outcomes Mineral and Bone Targets between 2010 and 2014 in Incident Dialysis Patients in France: the Photo-Graphe3 Study - Free, full-text, Advance Article from Clinical Kidney Journal. - September 23, 2017

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KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) - Article in Press Abstract from American Journal Of Kidney Diseases. - September 20, 2017

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Parathyroidectomy Associated With Morbidity, Mortality - Article from Renal & Urology News. - September 14, 2017

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Rockwell Medical Updates Progress on Calcitriol Commercial Launch - September 13, 2017

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Efficacy and Safety of Sevelamer Carbonate in Hyperphosphatemic Pediatric Patients with Chronic Kidney Disease - First Online abstract from Pediatric Nephrology. - September 12, 2017

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The Use of Bone Mineral Density Measured by Dual Energy X-Ray Absorptiometry (DXA) and Peripheral Quantitative Computed Microtomography in Chronic Kidney Disease - First Online abstract from Journal of Nephrology. - September 12, 2017

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Osteoporosis Drug Use in Chronic Kidney Disease - Article from Medscape Nephrology (registration required, but free). - September 9, 2017

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Paricalcitol Versus Calcifediol For Treating Hyperparathyroidism In Kidney Transplant Recipients - Article in Press abstract and full-text article (37-page PDF) from Kidney International Reports. - September 8, 2017

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  WEB RESOURCES
blue ball Latest Scientific Journal Articles on Bone Disease Continually Updated!
Bone Density Studies Benefits Brochure (pdf format requires Adobe Acrobat reader)  from the Centers for Medicare & Medicaid Services (CMS)
National Institutes of Health Osteoporosis and Related Bone Diseases - National Resource Center web site
Bone Disease from the Kidney Patient Guide web site of the UK
blue ball Bone and Mineral Metabolism - this is a growing library of key high-impact articles in nephrology, chosen by UKidney's contributors as suggested reading for nephrology trainees and practitioners.
AAKP Nutrition Coundter: A Reference for the Kidney Patient from the American Association of Kidney Patients web site
Chronic Kidney Disease Mineral and Bone Disorder in Children - full-text educational feature from Pediatric Nephrology
Mineral and Bone Disorder in CKD Stage 3 and 4 from the National Kidney Foundation web site
Renassist is a value-added program provided to patients to assist them in determining how they can access Renagel through their current health insurance from the Genzyme web site
Drug and Supplements Info: Calcium Carbonate from NLM MedLine Plus 
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  ESSENTIALS AND CLASSICS
Bone Mineral Metabolism Fact Sheet (pdf format requires Adobe Acrobat reader.) from the American Nephrology Nurses’ Association
Chronic Kidney Disease-Mineral and Bone Disorder - from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) web site
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Washington University Nephrology Web Episode - Bone Mineral Metabolism - Video from the Renal Fellow Network blog. 

Renal Osteodystrophy Topic from MedicineNet.com
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  PUBMED SEARCHES (National Library of Medicine's MEDLINE Database)
osteodystrophy AND dialysis   Continually Updated!
bone disease AND dialysis   Continually Updated!
phosphate binder   Continually Updated!
hyperparathyroidism AND dialysis    Continually Updated!
secondary hyperparathyroidism   Continually Updated!
MEDLINE / Pubmed Information from the National Library of Medicine
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  K/DOQI™ -  Kidney Disease Outcomes Quality Initiative
Clinical Practice Guidelines For Chronic Kidney Disease
 

  Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease
 

  Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease in Children
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  KDIGO™ -  Kidney Disease: Improving Global Outcomes
Clinical Practice Guidelines: Table of Contents
 

  Clinical Practice Guideline for CKD-Mineral and Bone Disorder (CKD-MBD) (Published 2017)

  WEB SEARCH ENGINES
Renal Osteodystrophy-related web pages by Yahoo! Continually Updated!
Renal Osteoporosis-related web pages by Yahoo! Continually Updated!
Renal Osteoarthritis-related web pages by Yahoo! Continually Updated!
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  DISCUSSION FORUM
General Dialysis Nursing Issues and Questions (No dedicated RenalWEB forum yet for this topic)
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  PRODUCTS
PHOSLYRA (calcium acetate oral solution) solution by Fresenius Medical Care North America
RenVela® Tablets (sevelamer) - phosphate binder
Hectorol™ Capsules (vitamin D analog for treating secondary hyperparathyroidism)
Rocaltrol ® brand of (calcitrol) Capsules and Oral Solution (vitamin D analog) - Product Information
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  RELATED TOPICS
Well Nourished Patient topic page from RenalWEB
aluminum and dialysis (PUBMED Search) Continually Updated!
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  INPUT / SUGGESTIONS
E-mail to RenalWEB on the Bone Disease Management Topic
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