• Childhood Kidney Diseases
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• 제24권1호
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• pp.14-18
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• 2020

Chronic kidney disease-mineral bone disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism caused by CKD. Patients with early-stage CKD who present with disordered regulation of bone and mineral metabolism may be asymptomatic. However, if untreated, the condition can be a significant barrier in achieving optimal bone strength, linear growth, and cardiovascular health in pediatric patients with CKD. Thus, the current study evaluated the definition, pathogenesis, diagnosis, and management of pediatric CKD-MBD.

• Childhood Kidney Diseases
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• 제18권2호
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• pp.64-70
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• 2014

목적: 본 연구는 만성복막투석환자에서 만성 신부전 무기질 골 장애의 목표 달성 정도의 평가와 중증 부갑상선기능항진증에서 비타민 D 치료에 대해 검토하였다. 방법: 본 연구는 2003년 1월부터 2012년 12월까지 1년 이상 복막투석을 시행한 53명의 환자를 대상으로 한 후향적 연구이다. 결과: 인산염 결합제제와 비타민 D 치료에도 불구하고 투석기간 중 인, 칼슘, PTH가 KDOQI의 목표치 내에 있었던 비율의 평균${\pm}$표준편차 값은 각각 $25.06{\pm}17.47%$, $53.30{\pm}23.03%$, $11.52{\pm}9.51%$이었다. 10명(18.9%)의 환자에서 CKD-MBD의 임상적 증상 혹은 영상의학적 징후가 있었고, 이는 증상 혹은 징후가 없었던 군과 비교하여 PTH가 목표치보다 높았던 시간의 비율이 길고($63.79{\pm}27.86%$ vs. $37.09{\pm}27.76%$, P=0.022) PTH가 목표치보다 낮았던 시간의 비율이 짧은 것($11.74{\pm}7.37%$ vs $40.77{\pm}25.39%$, P<0.001)과 유의한 상관관계가 있었다. 중증 부갑상선기능항진증이 있었던 25명의 환자 중 고용량비타민 D 치료를 받은 환자는 13명이었고 이 중 7명의 환자가 특별한 합병증 없이 부갑상선기능항진증이 조절되었다. 결론: 만성복막투석에서 CKD-MBD를 조절하기 위한 노력에도 불구하고 칼슘, 인, 비타민 D, PTH가 목표치를 만족하는 기간의 비율은 낮은편이다. 중증 부갑상선기능항진증 환자의 반 정도에서 고용량 비타민 D 치료가 필요하였고 이 중 50% 정도에서 효과가 있었다.

• 한국임상약학회지
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• 제26권2호
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• pp.97-106
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• 2016

Background: Sevelamer is associated with reduced complications of chronic kidney disease-mineral bone disorder (CKD-MBD) resulted from hyperphosphatemia, which may contribute mortality, in CKD patients with dialysis. So far clinical outcomes of sevelamer on mortality and risk of cardiovascular mortality related to CKD-MBD are debating. Purpose of this study was to evaluate the effectiveness of sevelamer HCl on mortality of secondary hyperparathyroidism (SHPT), risk of cardiovascular mortality and, frequency of osteopathy in end stage renal disease (ESRD) patients with dialysis. Methods: We retrospectively reviewed the electronic medical records of 536 patients with ESRD, who were admitted for moderate to severe SHPT, for 36 months. 75 patients who met inclusion criteria were evaluated for the efficacy of sevelamer (mean serum iPTH = 487.5 pg/mL). Results: Sevelamer intervention was not associated with increased three-year survival time compared with non-sevelamers group [average survival month: 30.4 months in sevelamer group, 26.8 months in non-sevelamer group, p = 0.463]. Sevelamer intervention was not associated with significant mortality benefit and cardiovascular mortality benefit as compared to non-sevelamer group [sevelamer group: non-sevelamer group, all-cause mortality (iPTH > 600 pg/mL): 14.3% (1/34): 20% (1/41) p = 0.962, OR = 0.935, 95% CI, 0.058-14.98, heart disease mortality: 6.67% (2/30): 0% (0/32) p = 0.138]. Sevelamer was not associated with significantly lower cumulative incidence of osteopathy compared to non-sevelamer group (sevelamer group: non-sevelamer group, 5.9% (2/34):9.8% (4/41); p = 0.538; OR = 0.578; 95% CI, 0.099-3.367). Conclusion: Sevelamer was not associated with decreased all-cause mortality and risk of cardiovascular mortality compared to non-sevelamer group in ESRD patients with SHPT.

• 한국임상약학회지
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• 제26권4호
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• pp.318-323
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• 2016

Background: Multidisciplinary team care (MTC) is a collaborative approach to treatment plan and ongoing care. We aimed to evaluate the clinical effect of MTC on the regulation of chronic kidney disease-mineral and bone disorder (CKD-MBD) complications in dialysis patients. Methods: This retrospective observational study was approved by the institutional review board. Among patients who have undergone dialysis at admission, the patients admitted to the nephrology ward were allocated to MTC group, and the others to usual care (UC) group. The MTC group had collaborative care by nephrologists, nurses, pharmacists, and nutritionists. The endpoints were the regulation of corrected calcium (cCa) and phosphate (P), the percent of patients in target level of cCa-P product ($cCa{\times}P$), and the prescription rate of non-calcium based P-binders. Results: A total of 163 patients were included from January to December 2009. A significant difference was shown in the percentage of patients in target $cCa{\times}P$ level at admission (MTC vs. UC, 81.40% vs. 91.67%; P = 0.038), but there was no significant difference at discharge. During admission, the cCa and P levels of patients in only UC group were significantly changed. In addition, compared with UC group, patients in MTC group were more likely prescribed appropriate P-binders, when they had higher $cCa{\times}P$ levels than $55mg^2/dL^2$ (P <0.001). Conclusion: It was found that MTC had beneficial effect on improving the regulation of CKD-MBD and the appropriate phosphate binder uses. Therefore, application of the MTC is anticipated to enhance quality of clinical care in chronic diseases.

• Childhood Kidney Diseases
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• 제25권2호
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• pp.117-121
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• 2021

Chronic kidney disease (CKD)-mineral and bone disorder (CKD-MBD) is a common complication of CKD, often accompanied by extra-skeletal calcification in adult patients. As increased vascular calcification is predicted to increase cardiovascular mortality and morbidity, the revised Kidney Disease: Improving Global Outcomes guidelines recommend avoiding calcium-containing phosphate chelators. However, extra-skeletal calcification is less commonly noticed in pediatric patients. Here, we report our experience of such a complication in pediatric patients receiving maintenance peritoneal dialysis. Extra-skeletal calcification was noticed at the corneas, pelvic cavity, and soft tissues of the lower leg in 4 out of 32 patients on maintenance peritoneal dialysis. These patients experienced the aggravation of extra-skeletal calcifications during peritoneal dialysis, and 2 of them underwent excisional operations. It is required to monitor extra-skeletal calcifications in children on kidney replacement therapy.