Meeting the K/DOQI Mineral and Bone Guidelines
in CKD (Stages 3 and 4): The Essential Role of Vitamin D

ASN Renal Week, October, 2004

Welcome, Introduction and Program Overview

Tilman B. Drueke, MD
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This group of talks is accredited for 1.5 CME Category 1 credits for physicians by the American Society of Nephrology. This group of talks has a single post-test, which must be completed along with an evaluation form to obtain continuing education credit.
Date of Web Release: February, 2005
CME Category 1 Credit Eligible Through: May 1, 2006
CME Category 1 Credits/Completion Time: 1.5
Target Audience: Practicing nephrologists and internists.
Method of participation: Listen to the talk(s), read the PubMed abstracts of linked slides and references, take the post-test, read the abstracts linked to in the post-test feedback section.
This official symposium was sponsored by a restricted educational grant from Bone Care International.
The educational objectives for this talk are presented on the conference page. To view the objectives, click here.

Dr. Drueke: grants, research support: Genzme; consultant: Genzyme; scientific advisor: Genzyme; honoraria: Genzyme; stocks: Genzyme; board position: Genzyme; other: Amgen, Genzyme, Hoffman La Roche.

No disclosed off-label use.

Accreditation Statement
The American Society of Nephrology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The ASN designates this educational activity for a maximum of 1.5 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The American Medical Association has determined that non-US licensed physicians who participate in this CME activity are eligible for AMA PRA category 1 credit.

Additional CME policy statements of the ASN, which is the accrediting organization for this talk, are given in detail on the ASN Renal Week Home Page, including Disclaimer and User Instructions.

The CME policy statements of HDCN are listed on this page.
Dr. Drueke:

We have two brilliant speakers with us: Dr. Jones, a biochemist, who will give us some general introduction into the relation between vitamin D and the kidney, and then Dr. Lindberg who will speak to the topic of the day; namely, how to achieve K/DOQI guidelines in stage 3 and 4 with new treatment possibilities.

We all know that the treatment of renal bone disease has been changing during the years. We initially were mostly concerned by high bone turnover disease and managed to get the bone turnover down, first with aluminum, and then with calcium carbonate and vitamin D, and as we know, we went too far to the other side. It may well be that in the future, because of concerns of various kinds, we will go back from low bone turnover to high bone turnover, which has caused ultimate good for the patients. In fact, we all know that there is a delicate balance in the control of secondary hyperparathyroidism: over-control on the one side with low vitamin D status, but on the other side, low turnover bone disease by over-control - either massive calcium carbonate or calcium acetate doses or vitamin overload. We know that we have a narrow window for clinical practice, so that the patients will have neither one or the other of the two, and so they will avoid soft tissue calcification.

We know that there are a number of possibilities. If you look only at drug possibilities, they are here - calcium supplements, phosphate binders other than calcium or aluminum-containing binders, vitamin D, and of course the question of the analogs, and as a very new drug, also, the calcimimetics. The question is - how good are we at present in controlling disturbances of calcium and phosphate metabolism in CKD patients? We know from ESRD patients that it is very difficult to achieve present K/DOQI guidelines with the means we have, but maybe this will be easier in the future. We do know nothing, I think, about the present achievement of goals of K/DOQI guidelines for CKD stages 3 and 4.

This meeting is meant to give at least some answer to the question - how we can best achieve good control (of mineral balance) in patients with early renal failure or with moderate renal failure? I think this is probably a key answer to good control in the long term.