Chronic Kidney Disease-Mineral and Bone Disorder Management in 4D: The Case for Dynamic Treatment Regime Methods to Optimize Care.

PURPOSE OF REVIEW: Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a complex condition impacting patients with kidney failure and characterized by inter-related features such as hyperparathyroidism, hyperphosphatemia, and hypocalcemia. Current treatments include active vitamin D sterols, calcimimetics, and phosphate binders alone and in combination. However, identifying optimal treatment is challenged by interdependency among CKD-MBD features, requiring new approaches to understand dynamic systems. In this review, we discuss challenges and opportunities for a more integrated view of CKD-MBD care. RECENT FINDINGS: Few clinical studies in CKD-MBD care have incorporated a dynamic understanding of the disorder and its treatment. Dynamic treatment regime methods are an evolving area of artificial intelligence (AI) that offer a promising approach for modeling and understanding CKD-MBD care. Efforts to date have included dynamic systems and quantitative systems pharmacology-based models to simulate the impact of alternative treatment regimes. Additional studies utilizing dynamic treatment regime approaches may help improve knowledge gaps in CKD-MBD care. Although preliminary research highlights the potential of dynamic treatment regime approaches in optimizing CKD-MBD management, further investigation and clinical validation are necessary to fully harness this approach for improving patient outcomes.

Duke Scholars

Author Julia Jarrard Scialla Medicine, Nephrology