New National Kidney Foundation Guidelines Warn of Negative Effects of Bone Disease in Children with Kidney Disease
New York, NY (October 4, 2005) - Osteodystrophy, also know as bone disease, affects more than the bones in children with chronic kidney disease (CKD), it also impacts growth and cardiovascular development, according to new guidelines developed through the National Kidney Foundation’s (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) and published as a supplement to the October 2005 issue of the American Journal of Kidney Diseases. The guidelines, Bone Metabolism and Disease in Children with Chronic Kidney Disease, warn that osteodystrophy begins early in the course of CKD in children and that children must be in calcium balance in order to grow and develop properly.
“The guidelines recommend that practitioners place a greater emphasis on vitamin D nutrition in children with CKD, the levels of parathyroid hormone, and the excesses of calcium intake from the use of calcium-based phosphate binders in children with advanced CKD which can lead to the development of vascular calcifications,” said Craig B. Langman, M.D., co-chair of the NKF work group that developed the guideline.
Isidro B. Salusky, M.D., co-chair of the guideline work group, highlighted additional key findings:
In patients with CKD stages 2-4, calcium-based phosphate binders are effective in lowering serum phosphorus levels,
In patients with CKD stage 5 (dialysis), both calcium-based phosphate binders and the non-calcium, non-metal-containing phosphate binders are effective in lowering serum phosphorus levels, but the long-term use of calcium-based binders is associated with the development of vascular calcifications in such patients,
The most accurate diagnostic test for determining the type of bone disease associated with CKD is iliac crest bone biopsy with double tetracycline labeling and bone histomorphometric analysis,
In patients with CKD serum levels of phosphorus should be adjusted according to age appropriate levels. Therapy with active vitamin D sterols should be initiated early in the course of CKD to prevent bone deformities.
According to Dr. Langman, the guidelines also offer research recommendations for topics such as bone mineral density testing in children with CKD, the effects of growth hormone combined with potent vitamin D metabolite analogues, and optimal therapeutic strategies for osteodystrophy.
Guideline Work Group
The NKF- KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Children with Chronic Kidney Disease are the culmination of three years’ work reviewing evidence published in peer-reviewed medical journals by eight volunteer experts in nephrology, pediatrics, nutrition, bone and mineral metabolism disorders, transplantation and epidemiology.
Abbott Laboratories is Primary Development Sponsor of the guideline. Additional support was received from Amgen, Inc. and Genzyme Therapeutics. Amgen, Inc. is Founding and Principal Sponsor of NKF-KDOQI. Sponsors are not involved in any aspect of the actual guideline development process.
To obtain more information about the guideline, call the National Kidney Foundation at (800) 622–9010 or (212) 889-2210, or visit www.kdoqi.org.
The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) provides evidence-based clinical practice guidelines developed by volunteer physicians and health care providers for all phases of kidney disease and related complications, from diagnosis to monitoring and management. K/DOQI expands the Dialysis Outcomes Quality Initiative or DOQI, a project begun by the National Kidney Foundation in 1995 and recognized throughout the world for improving the care of dialysis patients. For more information, please visit www.kdoqi.org.
About the National Kidney Foundation
The National Kidney Foundation is dedicated to preventing kidney and urinary tract diseases, improving the health and well being of individuals and families affected by these diseases, influencing public policy in support of the kidney community and increasing the availability of all organs for transplantation. For more information, please visit www.kidney.org.