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
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.
TO GO TO FIRST TALK by Glenville Jones CLICK HERE