In children who are still growing, CKD–MBD also causes bone pain, limb deformities, bone fracture, and growth retardation, which impair the patient’s quality of life. This CQ is aimed at determining whether appropriate management of parameters in CKD–MBD, such as serum calcium, phosphorus, and parathyroid hormone (PTH), improves growth and prevents CVD in children with CKD. An observational study employing bone www.selleckchem.com/products/repsox.html biopsies performed on 55 children undergoing peritoneal AZD5363 molecular weight Dialysis (PD) showed that higher levels of PTH were significantly associated with high-turnover lesions in the bone and lower levels of PTH with adynamic bone. In addition, an international
survey of 890 children undergoing PD showed that higher PTH levels were significantly associated with osteopenia, bone pain, limb deformities, growth retardation, and extraosseous calcifications. Therefore, serum PTH should be appropriately managed to prevent bone disorder and growth retardation. In regard to the prevention of CVD, studies in children and young adults showed that cardiac calcification
was associated with serum PTH, phosphorus, and Ca × P product. Other reports showed that carotid intima-media thickness correlated with Ca × P and that left ventricular hypertrophy and poor diastolic function correlated with higher levels of PTH in children with CKD. GSK458 datasheet Therefore, CKD–MBD should be appropriately managed to prevent CVD. The recommendations regarding the target levels of serum calcium, phosphorus, PTH, and Ca × P product are based on observational studies and international guidelines including the KDOQI Protirelin guidelines, KDIGO guidelines, and European Pediatric Dialysis Working Group guidelines. In summary, CKD–MBD should be managed appropriately to prevent growth retardation, bone disorder, and CVD. Bibliography 1. Seikaly MG, et al. Pediatr Nephrol. 2006;21:793–9. (Level 4) 2. Waller SC, et al. Kidney Int. 2005;67:2338–45. (Level 4) 3. Waller S, et al. Pediatr Nephrol. 2003;18:1236–41. (Level 4) 4. Salusky IB, et al. Kidney Int. 1994;45:253–8. (Level 4) 5. Borzych D, et al. Kidney Int. 2010;78:1295–304.
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