| Theme | Chronic kidney disease-mineral and bone disorder (CKD-MBD) guidelines: Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) 2017 CKD-MBD Guidelines Update | |
|---|---|---|
| Title | JSDT and KDIGO guidelines for CKD-MBD | |
| Publish Date | 2018/06 | |
| Author | Takayuki Hamano | Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine |
| [ Summary ] | Abnormalities in FGF23 and 25-hydroxyvitamin D (25 (OH) D) levels predict infection and renal outcomes. Recent findings concerning the effect of iron/ESA administration on FGF23 and inhibition of vascular calcification with iron treatment suggest a close link between CKDMBD and renal anemia. Thus, the concept of CKD-MBD is expanding. Given the association between FGF23 and congestive heart failure and its prevention with cinacalcet therapy, it is reasonable to include the heart as well as vessels into MBD-related organs as being associated. Functions of the heart rather than organic alterations of the heart such as left ventricular hypertrophy should be taken into account. Dietary differences between Japan and western countries may explain the difference in the prevalence of hyperphosphatemia in predialysis stages. Reimbursement policies for the measurement of 25 (OH) D, availability of vitamin D-fortified food, and doctors' prescription right of native vitamin D vary from country to country. These medical and cultural issues should be considered to understand the differences between the JSDT and KDIGO guidelines. The skeletal resistance to PTH in Japanese hemodialysis patients is expected to be lower than that of western patients. This may explain the lower target range of PTH in the JSDT guidelines. The high prevalence of patients having received long term dialysis in Japan has led to the inclusion of the management of amyloidosis into the JSDT guidelines. |
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