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Chronic kidney disease mineral bone disorder in childhood and young adulthood: a 'growing' understanding.

Authors
  • Lalayiannis, Alexander D1, 2
  • Soeiro, Emilia M D3
  • Moysés, Rosa M A4
  • Shroff, Rukshana5
  • 1 Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK. [email protected].
  • 2 University College London Great Ormond Street Hospital Institute of Child Health, London, UK. [email protected].
  • 3 Universidade Federal de Pernambuco, Recife, Brazil. , (Brazil)
  • 4 Sao Paulo University Faculty of Medicine, Universidade de Sao Paulo Faculdade de Medicina, São Paulo, Brazil. , (Brazil)
  • 5 University College London Great Ormond Street Hospital Institute of Child Health, London, UK.
Type
Published Article
Journal
Pediatric Nephrology
Publisher
Springer-Verlag
Publication Date
Mar 01, 2024
Volume
39
Issue
3
Pages
723–739
Identifiers
DOI: 10.1007/s00467-023-06109-3
PMID: 37624528
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Chronic kidney disease (CKD) mineral and bone disorder (MBD) comprises a triad of biochemical abnormalities (of calcium, phosphate, parathyroid hormone and vitamin D), bone abnormalities (turnover, mineralization and growth) and extra-skeletal calcification. Mineral dysregulation leads to bone demineralization causing bone pain and an increased fracture risk compared to healthy peers. Vascular calcification, with hydroxyapatite deposition in the vessel wall, is a part of the CKD-MBD spectrum and, in turn, leads to vascular stiffness, left ventricular hypertrophy and a very high cardiovascular mortality risk. While the growing bone requires calcium, excess calcium can deposit in the vessels, such that the intake of calcium, calcium- containing medications and high calcium dialysate need to be carefully regulated. Normal physiological bone mineralization continues into the third decade of life, many years beyond the rapid growth in childhood and adolescence, implying that skeletal calcium requirements are much higher in younger people compared to the elderly. Much of the research into the link between bone (de)mineralization and vascular calcification in CKD has been performed in older adults and these data must not be extrapolated to children or younger adults. In this article, we explore the physiological changes in bone turnover and mineralization in children and young adults, the pathophysiology of mineral bone disease in CKD and a potential link between bone demineralization and vascular calcification. © 2023. The Author(s).

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