Diagnóstico y tratamiento de las alteraciones oseominerales asociadas a la enfermedad renal crónica

Abstract

Chronic kidney disease (CKD) is associated with increased morbidity and mortality. In addition to traditional cardiovascular risk factors, other non-traditional factors have been described in this population. Thus, several mineral metabolism disturbances seem to contribute to the disproportionately high mortality rate. Chronic kidney disease-bone mineral disorder (CKD-MBD) has recently been defined as a systemic entity manifested by either one or a combination of the following factors: 1) biochemical abnormalities (calcium, phosphorus, parathormone and/or vitamin D metabolism), 2) abnormalities in bone biopsy; and/or 3) vascular or other soft tissue calcifications. In recent years, new therapies have been designed to control this entity, such as sevelamer, lanthanum carbonate, selective activators of vitamin D receptor and calcimimetics.The importance of sevelamer lies in its ability to attenuate progression of vascular calcifications and improve survival, described at least in certain groups of patients undergoing hemodialysis. Lanthanum carbonate effectively reduces serum phosphorus levels but because this drug was recently introduced, long-term outcomes are still not completely known. Nevertheless, preliminary retrospective data indicate survival benefits associated with its use. Selective activators of vitamin D receptor, such as paricalcitol, affect vascular calcifications differently from calcitriol, and have also been associated with increased survival in patients with CKD. Calcimimetics are highly useful for achieving the traditional goals of treatment guidelines and their long-term results are currently being evaluated in several ongoing prospective studies.Thus, although the various treatments of CKD-MBD should ideally be evaluated prospectively, the combination of several drugs can reasonably be considered to be superior to monotherapy.