Treatment of CKD-MBD targeted at lowering high serum phosphate and maintaining serum calcium

The management of chronic kidney disease-mineral bone disorders (CKD-MBD) strategies develops some major changes during the years, but it seems that the control of serum phosphorus levels is the most important factor to prevent clinical poor outcomes such as MBD and vascular calcification. Progressive decline in kidney function leads to phosphate retention (usually begins in CKD stage 3b) and decrease in the production of active vitamin D and increase parathyroid hormone (PTH) and fibroblast growth factor - 23. PTH and FGF-23 have same effect in decreasing phosphorus level. A key question rises here is which level of serum phosphorus in CKD stages can prevent these clinical outcomes Dietary phosphorus restriction, phosphate binder therapy and active vitamin D supplementation and adequate scheme of dialysis are the most important strategies for this goal of therapy.Today, although most centers decide to control serum phosphorus when the hypophosphatemia begin to happen,there are some evidences that it might be better to start to control serum phosphorus before the onset of hyperphosphatemia. Earlier phosphorus control and achieving normal phosphorus levels may help to reduce clinical consequences of CKD-MBD. But unfortunately control of serum phosphorus level is very difficult and hyperphosphatemia continues to be extremely common in CKD patients

کلیدواژه ها:

chronic kidney disease ، MBD ، hyperphosphatemia ، phosphate binders