Appendix 2: Controversies Conference Description and Agenda
KDIGO - Controversies Conference
Definition, Evaluation, and Classification of
Renal Osteodystrophy
Madrid, 15-17 September, 2005
BACKGROUND:
Renal osteodystrophy (ROD) has traditionally been defined as a disorder
of bone turnover, with bone biopsy the gold standard for diagnosis. In
contrast, osteoporosis has been diagnosed by abnormalities of DEXA. In
non-CKD patients there is an increasing appreciation that DEXA does not
accurately assess bone quality.
In the field of osteoporosis, there have been advances to develop better
serum markers and radiographic techniques to improve the ability to
diagnose abnormalities in bone and assess response to therapy. In
patients with CKD, there is uncertainty as to what an abnormal DEXA
means and whether or not abnormal values should be treated without
knowing the underlying bone histology.
At the 2003 National Kidney Foundation Controversies in Mineral
Metabolism and Bone Disease in CKD conference, it was suggested that the
term osteoporosis not be used in CKD, as renal osteodystrophy is a
disorder of remodeling (turnover), mass/volume relationship, and
microarchitecture. It is widely accepted to subdivide renal
osteodystrophy into 5 categories (osteitis fibrosa cystica, mild
secondary hyperparathyroidism, adynamic bone disease, osteomalacia, and
mixed uremic osteodystrophy) based on only a few parameters of
histomorphometry.
However, the interpretation and categorization of these biopsies is not
uniform internationally. Furthermore, bone biopsies have not been
considered practical for the clinical diagnosis in individual patients
and so serum PTH levels have been used as a surrogate marker. Recent
data have brought into question the utility of PTH with discordant
literature on the accuracy and reproducibility of different PTH assays.
Moreover, a validation of existing circulating markers of bone formation
and resorption in CKD patients is needed, and the development of novel,
more reliable markers should be encouraged.
The absence of a generally accepted consensus for the definition and
diagnosis of renal osteodystrophy shows that there is a need for
international consensus to facilitate the best clinical decision-making.
The focus of this meeting will be to review and confirm what we do know,
to establish a consensus on how we can most effectively use what we
know, to identify what we don’t know, and to prioritize and make
recommendations on how our knowledge can be expanded.
Meeting Objectives:
- To develop an internationally accepted definition of renal
osteodystrophy.
- To re-examine current histologic categories of renal
osteodystrophy and develop a consensus for bone biopsy
classifications.
- To define the serum markers, including appropriate PTH
assays, and imaging procedures that can allow the non-invasive
diagnosis and classification of renal osteodystrophy
CLICK HERE FOR MEETING AGENDA
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