4.7 Review

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

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Bone Mineral Density and Vascular Calcification in Children and Young Adults With CKD 4 to 5 or on Dialysis

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Summary: This multicenter longitudinal study found that while older adults with chronic kidney disease (CKD) may experience increases in bone mineral density (BMD), they can still develop vascular calcification. In contrast, the growing skeleton of children and young adults with CKD may offer protection against extraosseous calcification. These findings suggest that the growing skeleton may have a buffering capacity against non-skeletal calcification.

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The Role of Vitamin K in CKD-MBD

Maria Fusaro et al.

Summary: This review discusses the mechanism of action of vitamin K and its implications in cardiovascular disease, bone fractures, and inflammation. It highlights the protective role of vitamin K, especially in chronic kidney disease (CKD), and emphasizes the importance of vitamin K dosage in reducing bone fractures and improving vascular calcifications.

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Prevalence, progression and implications of breast artery calcification in patients with chronic kidney disease

Brecht Van Berkel et al.

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Summary: Traditionally, fetuin-A is known as an anti-calcification protein that prevents cardiovascular calcification. Recent evidence suggests that it also plays a crucial role in moderating tissue inflammation and fibrosis, as well as serving as a systemic indicator of acute inflammatory disease. In this context, unbalanced depletion of fetuin-A may trigger a vicious cycle of progressive calcification, inflammation, and tissue injury.

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Time for Revival of Bone Biopsy with Histomorphometric Analysis in Chronic Kidney Disease (CKD): Moving from Skepticism to Pragmatism

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Summary: Bone biopsy with histomorphometric analysis is the gold standard for diagnosing and classifying renal osteodystrophy. However, its use has declined due to various reasons. This position paper from Italian scientific societies aims to promote the use of bone biopsy and improve the management and prognosis of CKD patients through optimization and standardization of the procedure, establishment of a network, and reimbursement adjustments.

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Targeting a Silent Disease: Vascular Calcification in Chronic Kidney Disease

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Kimihiko Nakamura et al.

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Endeshaw Chekol Abebe et al.

Summary: Fetuin-A is a plasma glycoprotein with diverse physiological and pathological functions, involved in calcium metabolism, osteogenesis, and insulin signaling pathway. It also functions as a calcification inhibitor, protease inhibitor, and inflammatory regulator, and plays a crucial role in the pathogenesis of various disorders.

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The controversy of klotho as a potential biomarker in chronic kidney disease

Li-Xia Yu et al.

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Cortical bone density by quantitative computed tomography mirrors disorders of bone structure in bone biopsy of non-dialysis CKD patients

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Klotho in Clinical Nephrology Diagnostic and Therapeutic Implications

Javier A. Neyra et al.

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European Consensus Statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4-G5D

Pieter Evenepoel et al.

Summary: Treating osteoporosis in patients with CKD G4-G5D is challenging due to the complex pathophysiology and uncertainties surrounding diagnosis and treatment methods for fractures.

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The Non-invasive Diagnosis of Bone Disorders in CKD

Jordi Bover et al.

Summary: Abnormal bone metabolism is a key aspect of CKD-MBD, with renewed interest in bone as a new endocrine organ and the interaction between bone and vessels. CKD patients have a high risk of osteoporotic fractures, highlighting the need for improved non-invasive approaches to guide treatment decisions.

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Disorders in bone-mineral parameters and the risk of death in persons with chronic kidney disease stages 4 and 5: the PECERA study

Pablo Molina et al.

Summary: This study demonstrates a non-linear association between serum calcium, phosphate, and iPTH levels with mortality in CKD patients. There may be potential survival benefits for controlling bone mineral parameters, with specific optimal ranges identified for each biomarker.

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Calciprotein Particles Balancing Mineral Homeostasis and Vascular Pathology

Anton G. Kutikhin et al.

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Low bone turnover is associated with plain X-ray vascular calcification in predialysis patients

Ricardo Neto et al.

Summary: This study found that vascular calcification is highly prevalent in predialysis patients with chronic kidney disease, especially in those with diabetes. An independent factor associated with vascular calcification is low bone formation rate. Therefore, there is an important interaction between bone and vessel in chronic kidney disease patients.

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Is dual-energy absorptiometry accurate in the assessment of bone status of patients with chronic kidney disease?

K. Kim et al.

Summary: TBS and cQCT may accurately assess bone status in CKD patients as DXA could overestimate LS BMD, potentially due to increased AAC volume.

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Osteocalcin and vascular function: is there a cross-talk?

Alexander Tacey et al.

Summary: Current research on the interaction between OC and vascular function has produced conflicting results in humans, with some studies showing an association between total OC and vascular function while others do not. Animal studies indicate that direct administration of ucOC to blood vessels has minimal impact on endothelial function and no adverse effects. In vitro studies on human endothelial and vascular smooth muscle cells also suggest that ucOC treatment does not negatively influence cellular function, indicating a potential future therapeutic target for metabolic diseases.

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Vitamin D Supplementation for Patients with Chronic Kidney Disease: A Systematic Review and Meta-analyses of Trials Investigating the Response to Supplementation and an Overview of Guidelines

Marilena Christodoulou et al.

Summary: This study found that a high proportion of patients with chronic kidney disease are deficient in vitamin D, and the effect of vitamin D supplementation on PTH concentrations is inconsistent. Current guidelines recommend vitamin D management for CKD patients in different stages, with analogues consistently reducing PTH levels.

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Cardiovascular Disease in Chronic Kidney Disease Pathophysiological Insights and Therapeutic Options

Joachim Jankowski et al.

Summary: Patients with chronic kidney disease face an increased risk of cardiovascular events, with advanced CKD stages significantly elevating the risk. Cardiovascular events, rather than end-stage kidney disease, are the leading cause of death in this high-risk population, and CKD causes a proinflammatory state that affects the cardiovascular system.

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Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives

Luca Dalle Carbonare et al.

Summary: Bone biopsy for histomorphometric analysis provides quantitative information on bone remodeling and structure, particularly useful in diagnosing bone diseases such as renal osteodystrophy. Despite being the gold standard, its limited use is attributed to lack of expertise, cost, invasiveness, and pain associated with the procedure. Implementing sedation, standardizing analyses, and utilizing new tools can optimize the approach and utility of bone biopsy in managing CKD patients.

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Clinical Approach to Vascular Calcification in Patients With Non-dialysis Dependent Chronic Kidney Disease: Mineral-Bone Disorder-Related Aspects

Jordi Bover et al.

Summary: Chronic kidney disease (CKD) poses a high cardiovascular risk, often leading to CKD-mineral and bone disorders (CKD-MBDs) and subsequent vascular calcifications, which are prevalent and aggressive in CKD patients. Vascular calcification (VC) is a significant concern in CKD management, with potential implications for therapeutic interventions and patient risk stratification.

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Yan Chen et al.

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Correlation Between Soluble Klotho and Vascular Calcification in Chronic Kidney Disease: A Meta-Analysis and Systematic Review

QiFeng Liu et al.

Summary: The meta-analysis confirms a significant association between decreased levels of soluble Klotho (sKlotho) and increased risk of vascular calcification (VC) in patients with chronic kidney disease (CKD), supporting the potential use of sKlotho as a biomarker for VC in this population. Additional large prospective studies or interventional clinical trials are needed to validate these findings.

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Sclerostin and DKK1 circulating levels associate with low bone turnover in patients with chronic kidney disease Stages 3 and 4

Ricardo Neto et al.

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Can Sevinc et al.

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