Diagnosis and management of mineral metabolism in CKD.


Journal Article

BACKGROUND: Chronic kidney disease (CKD) affects over 26 million Americans and is frequently complicated early in its course by disordered mineral metabolism and metabolic bone disease. Since CKD-related bone loss is often indistinguishable from osteoporosis by standard bone densitometry, many CKD patients may be inappropriately treated with bisphosphonates rather than CKD-specific therapies. OBJECTIVE: To determine the prevalence of appropriate evaluation, diagnosis and management of metabolic bone disease among individuals with pre-dialysis CKD. DESIGN AND PARTICIPANTS: Retrospective cohort study using electronic medical records of 69,215 ambulatory patients seen in the primary care clinics of an academic medical center. MEASUREMENTS: Prevalence of CKD stages 3-4, frequency of diagnostic testing and treatment of metabolic bone disease. MAIN RESULTS: Based on current diagnostic criteria and consistent with national data, CKD was present in 12% of the population. Bisphosphonates were used in 7.2% of patients, 20% of whom met criteria for CKD. Fewer than half of CKD patients underwent testing for parathyroid hormone (PTH) or 25-hydroxyvitamin D (25D) levels. Among those tested, vitamin D deficiency (25D <30 ng/ml) and secondary hyperparathyroidism (PTH >60 pg/ml) were present in 65% and 55%, respectively. Among patients with CKD, bisphosphonate use was nearly seven times as frequent as therapy with active vitamin D (12% vs. 1.7%, p < 0.0001), a primary treatment for CKD-associated metabolic bone disease. CONCLUSIONS: Disordered mineral metabolism in CKD is common, under-diagnosed and under-treated. As a result, bisphosphonates may be prescribed inappropriately in patients with CKD.

Full Text

Duke Authors

Cited Authors

  • Bhan, I; Dubey, A; Wolf, M

Published Date

  • July 2010

Published In

Volume / Issue

  • 25 / 7

Start / End Page

  • 710 - 716

PubMed ID

  • 20352364

Pubmed Central ID

  • 20352364

Electronic International Standard Serial Number (EISSN)

  • 1525-1497

Digital Object Identifier (DOI)

  • 10.1007/s11606-010-1316-y


  • eng

Conference Location

  • United States