Kidney and bone update : the 5-year history and future of CKD-MBD. Bone metabolic marker in hemodialysis patients update]

Disturbances in mineral metabolism and bone disease are common complications of chronic kidney disease (CKD) . There is increasing evidence suggesting that these disorders in mineral and bone metabolism are associated with increased risk for cardiovascular calcification, morbidity, and mortality, especially among those who undergo maintenance hemodialysis. It is very important for hemodialysis patients to assess the mineral and bone abnormalities. Although bone biopsy is necessary to diagnosis of renal osteodystrophy in CKD-mineral and bone disorder (CKD-MBD) classification system, this technique is not recommended of routine evaluation for this bone disease. Thus, the presumption of bone disorder in hemodialysis patients has been essentially based on the parathyroid hormone level. However, it is obvious that measurement of parathyroid hormone dose not provide sufficient information. The parathyroid hormone level basically reflects the degree of activity of parathyroid glands and the CKD state is often associated with resistance of bone to the action of parathyroid hormone. Therefore, measurement of bone metabolic markers, such as bone specific alkaline phosphatase and tartrate-resistant acid phosphatase isoform 5b, is increasingly recognized as a useful tool to assess bone metabolic states in hemodialysis patients. Bone metabolic markers may be useful for assessment in the rate of bone loss, the risk of fracture, and the effects of therapy as in osteoporotic patients without CKD.