Tag: Phosphorus

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Lecture on CKD-MBD

The St John Nephrology Fellowship is excellent. One of the reasons it is good is  we continually use feedback to fix holes. In last year’s in-service exam we found some weakness in calcium so I was asked to buff the fellows calcium knowledge.

Today I started that with a lesson on CKD-MBD where we focused on the KDIGO 2017 update. I pulled what I feel are the the most important articles in this area published recently. Here is what I pulled:

PRIMO. Paricalcitol in pre-dialysis CKD does not magically heal the heart.
Phosphate binder network meta analysis. Concluded that calcium-free based binders are better. All binders have lots of side effects.
The guideline
Executive summary of the guideline with a useful side-by-side comparison of the 2009 and 2017 guidelines.
Phosphorus binders in pre-CKD patients don’t do a lot of good and increase coronary calcification.
Evolve. Prospective data in CKD MBD that produced a nice separation in PTH and not much else.
FGF-23 still has not made it into the guidelines but it is the phantom menace soon to be unveiled.

What did articles did I miss? What are your favorite CKD-MBD articles

P.S. My favorite part of the guidelines, the part that tell you everything you need to know about KDIGO is 4.2.2:

Here it is in 2009:

And here it is in 2017

And the best part is how the level of evidence has not changed. 2C for both. It’s like they just woke one morning on a different side of the bed.

Great update from Swapnil