Liječnički vjesnik, Vol. 138 No. 5-6, 2016.
Professional paper
GUIDELINES FOR THE PREVENTION, MONITORING AND THERAPY OF CHRONIC KIDNEY DISEASE-METABOLIC BONE DISEASE IN PATIENTS WITH CHRONIC KIDNEY DISEASE
Nikolina Bašić-Jukić
Draško Pavlović
Ružica Šmalcelj
Hrvojka Tomić-Brzac
Lidija Orlić
Josipa Radić
Božidar Vujičić
Vesna Lovčić
Eva Pavić
Dragan Klarić
Marijana Gulin
Goce Spasovski
Dragan Ljutić
Davorin Đanić
Drago Prgomet
Halima Resić
Marina Ratković
Petar Kes
Sanjin Rački
Abstract
Chronic kidney disease (CKD) is a systemic disease with numerous complications associated with increased morbidity and mortality. Chronic kidney disease-metabolic bone disease (CKD-MBD) starts at early stages of CKD with phosphorus accumulation and consequent initiation of numerous events that result with the development of secondary hyperparathyroidism with changes on bones and extraskeletal tissues. The most important and clinically most relevant consequences of CKD-MBD are vascular calcifications which contribute to cardiovascular mortality. Patients with the increased risk for the development of CKD-MBD should be recognized and treated. Prevention is the most important therapeutic option. The first step should be nutritional counseling with vitamin supplementation if necessary and correction of mineral status. Progression of CKD requires more intensive medicamentous treatment with the additional correction of metabolic acidosis and anemia. Renal replacement therapy should be timely initiated, with the adequate dose of dialysis. Ideally, preemptive renal transplantation should be offered in individuals without contraindications for immunosuppressive therapy
Keywords
Renal insuffi ciency, chronic – complications, metabolism, therapy; Bone diseases, metabolic – etiology, diagnosis, complications, therapy, prevention and control; Bone and bones – metabolism, pathology; Hyperparathyroidism, secondary – etiology, diagnosis, therapy, prevention and control; Parathyroidectomy – methods; Hyperphosphatemia – complications, therapy; Renal osteodystrophy – etiology; Vascular calcifi cation – etiology; Renal dialysis; Practice guidelines as topic; Croatia
Hrčak ID:
172850
URI
Publication date:
30.6.2016.
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