| [ Summary ] |
Prevention of disturbances in mineral and bone metabolism and their management in hemodialysis patients are extremely important in improving patient quality of life, reducing cardiovascular complications, and avoiding increased morbidity and mortality. Calcium, phosphorus, vitamin D, PTH, trace metals (aluminum, iron, strontium etc.), FGF-23, fetuin-A, uremic toxins including homocysteine and drugs, including calcimimetics, appear to be associated with renal osteodystrophy. The key findings of the K / DOQI guidelines released on bone metabolism and disease in hemodialysis patients are : serum levels of corrected total calcium, phosphorus, calcium-phosphorus products, intact PTH and aluminum should be maintained at levels of 8.4 - 9.5 mg / dl, 3.5 - 5.5 mg / dl, < 55 mg2 / dl2, 150 - 300 pg / ml, < 20 μg / l. Dialysate calcium and aluminum concentrations should be maintained at 2.5 mEq / l，Al < 10 μg / l. There have been some problems in adapting the K / DOQI guidelines for Japanese hemodialysis patients. Therefore, Japanese guidelines should be established. |