A completely now approach to the issue of bone disease in patients with chronic kidney disease – what KDIGO practice recommendations can we expect? Commentary on the KDIGO 2025 Controversies Conference.
Authors:
Palička Vladimír 1; Sulková Dusilová Sylvie 2
Authors place of work:
Ústav klinické biochemie a diagnostiky, Osteocentrum, FN a LF UK v Hradci Králové
1; Nefrologická klinika FN a LF UK v Hradci Králové
2
Published in the journal:
Clinical Osteology 2025; 30(1): 6-12
Category:
Hlavní téma
Summary
In 2006, the KDIGO initiative acknowledged the link between cardiovascular damage and bone disorders by incorporating a so called “vascular component” into the CKD-MBD concept. However, renal osteodystrophy continued to be viewed as a distinct and specific bone pathology within nephrology.
In recent years, this perspective has begun to shift. Renal osteodystrophy, traditionally the domain of nephrologists, and osteoporosis, the domain of osteologists, are now increasingly converging and overlapping. The impetus for this change came from new insights into the importance of bone densitometry in nephrology and the high fracture risk among nephrology patients.
The new KDIGO proposal, presented in this text, goes even further. It places renal osteodystrophy within the broader context of bone pathologies grouped under the term “osteoporosis”, which are clinically defined primarily by a high fracture risk.
In addition to traditional secondary hyperparathyroidism, the proposal emphasizes other contributing factors. It even hypothetically considers a shift away from relying solely on parathyroid hormone levels toward the use of bone turnover markers – though their accumulation due to impaired renal clearance remains a concern.
Many other connections and reasons are discussed as to why renal osteodystrophy is now being viewed in a new light. The theses of this Controversies Conference will be further elaborated, and the conclusions will inform a future new version of the KDIGO guidelines. However, it is already clear that a fundamental shift in the overall approach is underway.
Keywords:
renal osteodystrophy, CKD-MBD concept, osteoporosis, CKD-associated osteoporosis, KDIGO Controversies Conference.
Zdroje
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Štítky
Biochemie Dětská gynekologie Dětská radiologie Dětská revmatologie Endokrinologie Gynekologie a porodnictví Interní lékařství Ortopedie Praktické lékařství pro dospělé Radiodiagnostika Rehabilitační a fyzikální medicína Revmatologie Traumatologie OsteologieČlánek vyšel v časopise
Clinical Osteology
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