Mineral and Bone Initiative
KDIGO Controversies Conference on Definition, Evaluation, and Classification of Renal Osteodystrophy
Clinical Practice Guidelines for the Management of Mineral and Bone Disorder
Clinical Guide: Basics of Bone and Mineral Metabolism in CKD – Professional Education Text
Bone Biopsy Quality Initiative
Background
Over the last decade there have been significant advances in the field of bone and mineral metabolism in patients with chronic kidney disease. Our diagnostic capabilities have been enhanced through the development of innovative techniques in radiographic imaging and new assay methodologies for PTH and other bone markers. New vitamin D analogs and phosphate binders, as well as calcimimetics, have been added to our therapeutic regimens. In addition, advances in the basic sciences of bone and vascular biology have led to improved understanding of vascular pathology and calcification, as well as new diagnostic techniques and therapies for the management of osteoporosis in the general population. Most importantly, we have gained an increased understanding and appreciation of the extraskeletal manifestations of mineral metabolism.
Despite the recent advances, a lack of consensus continues among clinicians worldwide on how to integrate these findings and therapeutic approaches into clinical practice; therefore, the management of bone and mineral metabolism in CKD patients remains fragmented and controversial. To begin to address these issues, in March 2003, the National Kidney Foundation held a conference in Washington, DC on “Controversies in Mineral Metabolism and Bone Disease in CKD.” This conference brought together a distinguished group of international experts in bone and mineral metabolism. After reviewing the most recent developments and the current clinical guidelines, the group made a series of recommendations on diagnostics, outcomes research and education initiatives designed to improve outcomes in renal osteodystrophy.
- Cunningham J, Sprague SM, Cannata-Andia J, Coco M, Cohen-Solal M, Fitzpatrick L, Goltzmann D, Lafage-Proust MH, Leonard M, Ott S, Rodriguez M, Stehman-Breen C, Stern P, Weisinger J: Osteoporosis in chronic kidney disease. Am J Kidney Dis 43:566-571, 2004
- Goodman WG, London G, Amann K, Block GA, Giachelli C, Hruska KA, Ketteler M, Levin A, Massy Z, McCarron DA, Raggi P, Shanahan CM, Yorioka N: Vascular calcification in chronic kidney disease. Am J Kidney Dis 43:572-579, 2004
- Martin KJ, Olgaard K, Coburn JW, Coen GM, Fukagawa M, Langman C, Malluche HH, McCarthy JT, Massry SG, Mehls O, Salusky IB, Silver JM, Smogorzewski MT, Slatopolsky EM, McCann L: Diagnosis, assessment, and treatment of bone turnover abnormalities in renal osteodystrophy. Am J Kidney Dis 43:558-565, 2004
- Moe SM, Drueke TB: A bridge to improving healthcare outcomes and quality of life. Am J Kidney Dis 43:552-557, 2004
- Druek TD, Moe SM: Disturbances of bone and mineral metabolism in chronic kidney disease: an international
initiative to improve diagnosis and treatment. Nephrol Dial Transplant 2004 Mar; 19(3):534-6.
The KDIGO Bone and Mineral Initiative Workgroup evolved from the Controversies in Mineral Metabolism and Bone Disease in CKD conference.
This globally integrated initiative was designed to facilitate the recommendations of the conference attendees. Over the last several years, the KDIGO-Bone and Mineral Workgroup has developed a number of international programs to advance knowledge in diagnosing and treating the mineral and bone disorders of CKD.
CLINICAL PRACTICE GUIDELINES
In an attempt to incorporate recent therapeutic advancements and to address ongoing controversies in patient management, several sets of clinical practice guidelines on the management of bone metabolism in CKD have been developed.
- Caring for Australians with Renal Impairment (CARI) Clinical Practice Guidelines
- European Best Practice Guidelines
- National Kidney Foundation-KDOQI Clinical Practice Guidelines
- UK Renal Association Clinical Practice Guidelines
The KDIGO Database Workgroup has developed comparative tables of recommended guideline targets for various physiological parameters in bone and mineral metabolism that can be viewed here.Guideline Summary
Most recently, the National Kidney Foundation, as part of its Kidney Disease Outcomes Quality Initiative (KDOQI), formed a work group that proposed a comprehensive set of 17 clinical practice guidelines specific to the management of bone metabolism and disease in children with CKD.
KDOQI Guidelines for Children.
KDIGO International Clinical Practice Guidelines
In 2006, KDIGO will support the development of an international workgroup to propose new universal clinical practice guidelines for mineral and bone disorders in CKD. The KDIGO guidelines will be an update to the KDOQI guidelines and will integrate the newest scientific research and existing regional guidelines to improve outcomes on a global basis. News Release
CLINICAL GUIDE: BASICS OF BONE AND MINERAL METABOLISM IN CKD
The KDIGO-Mineral and Bone Workgroup facilitated the development of this comprehensive clinical education text that was published in January, 2006. This landmark educational tool was written for an international audience to provide critical knowledge on the pathophysiology and clinical management of the abnormalities of mineral and bone metabolism that are prevalent in CKD.
The content of the Clinical Guide includes:
- Basic bone and mineral physiology
- Diagnostic approaches, including bone biopsy, imaging techniques
and bone biomarkers - Pathophysiology and clinical manifestations of secondary
hyperparathyroidism, renal osteodystrophy, and extraskeletal
calcification - Therapeutic options to manage bone and mineral disorders
- Unique aspects of bone and mineral metabolism in special
populations - children, hypogonadism, and kidney transplantation - Epidemiologic data linking abnormalities of bone and mineral
metabolism to morbidity and mortality
The Clinical Guide to the Basics of Bone and Mineral in CKD can be ordered by completing the order form here and mailing or faxing as indicated. This professional education text costs $30.00 U.S. The order number is 12-50-2248. For shipments outside of North America costs vary considerably depending on destination, but typically run between $50.00-75.00 (U.S.)
BONE BIOPSY QUALITY INITIATIVE
KDIGO is facilitating the development and implementation of an international workgroup whose primary objectives will be to:
- Develop quality control protocol with ongoing inter lab exchange of bone biopsy samples to determine inter lab variability and promote quality/standardization in reporting histomorphometric results.
- Develop mechanism to collect all available normative data for bone biopsies. This could be both perspective and retrospective readings on normal population.
