| [ Summary ] |
The new Japanese Guidelines on CKD-MBD published in 2012 are comprehensive in that they contain amyloidosis as well as vascular calcification and that they cover pre-dialysis and post-transplantation phases. The targets of laboratory data for dialysis patients were determined from the perspective of mortality. However, given much lower mortality rate in Japanese patients compared to Western patients with CKD, we will encounter problems of statistical power in setting target ranges for pre-dialysis patients if we continue the same approach. From this point of view, including renal outcome among important clinical outcomes will solve the problem. Key issues for evolving guidelines include individualization of therapy according to patients' attributes, determination of the optimal intensity of therapy (how aggressive therapies should be), pharmacoeconomics, and selection of an appropriate therapy among many options to control laboratory data. The last issue will be addressed only by randomized controlled trials. |