| [ Summary ] |
The Guidelines concerning secondary hyperpararhyroidism in dialysis patients have recently been released in Japan. In these guidelines, the optimal ranges of laboratory values including serum phosphorus, calcium and intact PTH, were determined based on the association of these parameters with mortality. These guidelines extend to the predialysis and post-transplant periods. However, we have many problems in developing guidelines for CKD-MBD (chronic kidney disease-mineral and bone disorders) in predialysis patients. First, we lack evidence regarding bone metabolism in Japanese predialysis patients. Secondly, the goals for regulating CKD-MBD are not clear. Should we regulate bone metabolism in order to preserve renal functions, to improve mortality by decreasing cardiovascular events, or to decrease bone fracture rates ? In this article, quoting evidence from western countries, it will be illustrated that these three goals can be achieved simultaneously what should be done before developing guidelines concerning bone metabolism in predialysis patients is also examined. |