| [ Summary ] |
In the revised Kidney Disease : Improving Global Outcomes guidelines on chronic kidney disease-mineral and bone disorder (CKD-MBD) that will be published soon, the usefulness of bone mineral density (BMD) measurement will be depicted. Moreover, lack of bone biopsy data does not preclude the rationale of prescribing antiresorptive agents to high-risk patients. The uniqueness of the current Japanese CKD-MBD guidelines lies in the lower target ranges of intact PTH levels, prioritization of the control of serum phosphate and calcium levels over the control of PTH levels, and its reference to the bone phenotype of renal amyloidosis. In the era of cinacalcet, which prevents high PTH levels, the major problem is how to manage low PTH levels. In the current Japanese guidelines, the lower limit of the target PTH range is 60 pg/mL. Such evidence warrants the validity of this limit that any intervention to increase PTH in the patients with PTH<60 pg/mL would improve a certain clinical outcome. |