People with Chronic Kidney Disease (CKD) often develop Mineral and Bone Disorders because kidneys that have failed or are in the process of failing cannot maintain the proper levels of calcium and phosphorus in the blood, leading to abnormal bone hormone levels. It is a common problem in most people with CKD and is a very serious condition in almost all individuals receiving dialysis. Mineral and Bone Disorders slow bone growth and cause deformities such as legs bending inward toward each other or outward away from each other (renal rickets).
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Symptoms of the disease begin many years before they clearly appear and for this reason is called the “silent crippler.” If Mineral and Bone Disorders are left untreated then the bones gradually become thin and weak, and a person with CKD may begin to feel bone and joint pain as well as increase risk of severe bone fractures.
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A new study reported in the American Journal of Kidney Diseases, found that hip fracture rates increased relatively rapidly among dialysis patients from 1993 (23.4 events per 1,000 person-years) until 2004 (41.4 events per 1,000 person-years) and then decreased to 31.9 events per 1,000 person-years by 2010. Lead researcher, Dr. Thomas J. Arneson, noted that changes in the management of Mineral Bone Disease in CKD patients may partially explain the hip fracture trends in dialysis cohorts. Market introduction of agents such as Cinacalcet (drug that mimics the action of calcium on tissues) and Lanthanum Carbonate (a non-calcium phosphate binder) may explain the steep downward trend in fracture rates.
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Mineral and Bone Disorders can be treated with changes in your diet. Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease. Although almost all foods contain phosphorus it is especially high in milk, cheese, dried beans, peas, nuts, and peanut butter. Often, medications called phosphate binders such as calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer hydrochloride (Renagel), or lanthanum carbonate (Fosrenol)are prescribed with meals and snacks to bind phosphorus in the bowel. These medications decrease the absorption of phosphorus into the blood. A Renal Dietitian can help develop a dietary plan to control your phosphorus levels. By increasing your time on dialysis you can further help control phosphorus levels.
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If your kidneys are not able to make the adequate amount of vitamin D (calcitriol) you can take a synthetic pill called Rocaltrol or an injectable medication, Calijex. You should note that controlling PTH levels prevents damage to bones so your Nephrologist may prescribe a calcium supplement in addition to calcitriol which will lower your PTH levels by imitating calcium’s effects on the parathyroid gland. However, if PTH levels cannot be controlled then your parathyroid glands may need to be removed surgically.
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A good treatment program, including proper attention to diet, dialysis, and medications, can improve your body’s ability to repair bones damaged by common Mineral and Bone Disorders. Overall bone health can also be improved by exercising and not smoking. KidneyBuzz.com encourages CKD patients to talk with their healthcare team before augmenting their treatment plan in any way.
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"Hemodialysis Patients Suffering Fewer Hip Fractures." Renal and Urology News.
"Review Article: Bone Density in Patients with Chronic Kidney Disease Stages 4-5." US National Library of Medicine National Institutes of Health.
"Chronic Kidney Disease-Mineral and Bone Disorder." National Kidney and Urologic Diseases Information Clearinghouse. NATIONAL INSTITUTES OF HEALTH