What Is Mineral and Bone Disorder in Chronic Kidney Disease?
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Mineral and Bone Disorder in Chronic Kidney Disease

Published on Oct 26, 2022 and last reviewed on Sep 08, 2023   -  4 min read

Abstract

Chronic kidney disease results in an imbalance in the calcium and phosphorus level in the blood, which causes mineral and bone disorders.

What Is Mineral and Bone Disorder in Chronic Kidney Disease?

Chronic kidney disease leads to impairment in kidney function and loss of glomerular filtration rate. This exacerbates disturbances in mineral metabolism and deteriorates the bone microstructure. The remodeling of the bone and calcium and phosphorus metabolism causes chronic kidney disease-mineral bone disease. The disease is characterized by -

1. Abnormal Metabolism of Calcium, Phosphorus, Parathyroid Hormone, or Vitamin D -

Abnormal metabolism of phosphorus can lead to hyperphosphatemia. Vitamin D deficiency causes renal osteodystrophy, uremic osteoporosis, and vascular calcification.

2. Abnormalities in Turnover, Mineralization, Volume Linear Growth, or Strength of Bone -

Down-regulation of bone turnover by a uremic toxin or secondary hyperparathyroidism disturbed bone mineralization causing problems for the calcium and inorganic phosphate to penetrate the bone. This results in increased serum calcium and inorganic phosphate.

3. Soft Tissue Calcifications in Vascular or Extraosseous Parts -

Uremic vascular calcification and osteoporosis are widespread complications of mineral and bone disorders in chronic kidney disease. The vascular calcifications are deteriorated by hyperphosphatemia and systemic inflammation.

What Are the Causes of Mineral and Bone Disorders in Chronic Kidney Disease?

Kidney impairment from chronic kidney disease causes mineral and bone disorders because the damaged kidneys fail to balance the mineral and hormone levels in the body. Injured kidney resists -

What Are the Symptoms of Mineral and Bone Disorder in Chronic Kidney Disease?

The symptoms of mineral and bone disorder due to chronic kidney failure include -

  • Anemia.

  • Pain and stiffness in joints.

  • Weak bones that fracture easily.

  • Spontaneous tendon rupture.

  • Proximal muscle weakness.

  • Blocked blood vessels.

  • Extraskeletal calcifications involve the vasculature and calcification of the skin.

  • Cardiovascular calcification.

  • Stunted growth in children.

  • Itchy skin.

  • Nerve problems.

  • Compromised immunity.

What Are the Complications of Mineral and Bone Disorder in Chronic Kidney Disease?

The complications arise due to an imbalance in the calcium and phosphorus mechanism caused by kidney impairment. It includes -

  • Bone fractures occur due to the shifting of calcium from bones to the blood. Bones slowly become narrow and weak. Bones and joints become painful and create a risk of osteoporosis. In severe conditions, osteoporosis increases the risk of fractures or broken bones.

  • Hampered growth of the bone and bone deformities due to loss of calcium from the bones to the blood. Restricted bone growth leads to short stature; such deformity is also called renal rickets. Renal rickets is characterized by leg bending inward or outward and an increased likelihood of bone fractures.

  • Heart and blood vessel problems arise due to high levels of calcium and phosphorus in the blood. It causes the hardening of the blood vessels called calcification. Abnormal hormone regulation even when the calcium levels in the blood are normal. The increased levels of parathyroid hormone harm the bone, heart, and blood vessels.

  • Complications arising as a result of mineral and bone disorders cause prolonged hospitalization, poor quality of life, high risk of bone fractures, and eventually death.

How Is Mineral and Bone Disorder in Chronic Kidney Disease Diagnosed?

The diagnosis is made based on the presence of chronic kidney disease and a family history of mineral and bone disorders. The diagnosis can be made by the following methods -

  1. Blood Test - A blood test is done to check for the levels of calcium, phosphorus, parathyroid hormone, and vitamin D.

  2. Computerized Tomography (CT) Scan - A CT scan of the bones to check for the presence of calcification in the heart and blood vessels can be done.

  3. X-ray - An X-ray can be done to check bone structure and inconsistencies in it.

How Is Mineral and Bone Disorder in Chronic Kidney Disease Treated?

The treatment goal for mineral and bone disorders is to control mineral and hormone levels to prevent bone and blood vessel damage.

1. Diet and Nutrition - A lower phosphorus diet can help keep the blood phosphorus level in the normal range. Avoid consumption of foodstuffs containing phosphorus, such as processed and packaged foods, canned or boxed foods, and foodstuffs containing preservatives.

2. Medications - Medications to restore the balance of minerals and hormones in order to make adequate amounts of calcitriol; a variety of medications can be prescribed, such as synthetic calcitriol to reduce the parathyroid hormone levels, calcium supplement, and vitamin D, calcimimetics to lower the parathyroid hormone levels, and phosphate binders to bind the phosphorus in the food and keep it from being absorbed into the intestines.

3. Dialysis - Dialysis needs to be done when the kidneys are unable to filter the waste products and maintain the fluid, mineral, and hormonal balance. There are two forms of dialysis

  • Hemodialysis.
  • Peritoneal dialysis.

4. Kidney Transplant - A permanent solution for kidney impairment is to transplant a donated kidney into the body. The transplanted kidney performs normal functions and prevents the symptoms of chronic kidney disease.

5. Parathyroidectomy - Parathyroid hormone levels need to be controlled to prevent loss of calcium from the bones. If diet, medicines, and dialysis cannot control the parathyroid hormone levels, removal of the parathyroid gland needs to be done. This procedure of removing the parathyroid gland is called a parathyroidectomy.

Conclusion :

A nutritional supplement of vitamin D plays an important role in renal osteodystrophy, uremic osteoporosis, and vascular calcification. It also improves the bone remodeling initiated by osteoblast cells and eliminates the risk factors for vascular calcification. Therefore, nutritional supplements of vitamin D should be considered in the treatment of chronic kidney disease-mineral and bone disorders. Mineral and bone disorder generally occurs in people with chronic kidney disease, kidney failure, and dialysis. Severe forms of chronic kidney disease-mineral and bone disorders can be avoided by following the proper diet plan and taking phosphate binder medications. The imbalance in the calcium and phosphorus levels needs to be evaluated and treated promptly. Non-calcium-containing phosphate binders should be used to prevent calcium intake in patients on dialysis to help control serum phosphorus and calcium intake.

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Last reviewed at:
08 Sep 2023  -  4 min read

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