Current and Emerging Markers and Tools Used in the Diagnosis and Management of Chronic Kidney Disease-Mineral and Bone Disorder in Non-Dialysis Adult Patients

Chronic kidney disease (CKD) is a significant public health concern associated with significant morbidity and has become one of the foremost global causes of death in recent years. A frequent comorbidity of CKD is secondary hyperparathyroidism (SHPT), exemplified by high serum parathyroid hormone (PTH) levels. The mineral metabolism disturbances resulting from CKD and progression to SHPT are currently considered part of the definition of chronic kidney disease-mineral and bone disorder (CKD-MBD). However, CKD-MBD does not only include abnormalities in laboratory-measured parameters; it is a complex condition characterized by dysregulation of bone turnover, mineralization, growth and strength, accompanied by vascular or another soft-tissue calcification. Together, this increases the risk of bone fractures, cardiovascular disease, and overall mortality in CKD-MBD patients. Monitoring serum markers is essential in diagnosing SHPT and CKD-MBD, and there are several recognized indicators for prognosis, optimal clinical management and treatment response in late-stage kidney disease patients receiving dialysis. However, far fewer markers have been established for patients with non-dialysis CKD. This review provides an overview of current and emerging markers and tools used in the diagnosis and management of CKD-MBD in non-dialysis adult patients.

Automated summary

Chronic kidney disease (CKD) is a major public health concern associated with significant morbidity and mortality. Secondary hyperparathyroidism (SHPT) is a common comorbidity of CKD, characterized by high levels of parathyroid hormone (PTH) in the blood. CKD-MBD, which includes mineral metabolism disturbances and bone disorders, is considered as part of the definition of CKD. It is a complex condition involving dysregulation of bone turnover, mineralization, growth, strength, as well as vascular or soft-tissue calcification. This increases the risk of fractures, cardiovascular disease, and overall mortality in CKD-MBD patients. Monitoring serum markers is crucial for diagnosing SHPT and CKD-MBD, and there are different markers for late-stage kidney disease patients receiving dialysis and non-dialysis CKD patients.