Bone and Mineral Disorder Prevention and Management: What to Do? (Research Review‪)‬

One of the more significant challenges facing chronic kidney disease (CKD) patients in later stages and on dialysis is the need to manage the intricate bone and mineral imbalances that occur as a result of loss of kidney function. To assist in managing the complexities, clinical practice guidelines have been written for treating mineral and bone disorders in CKD--the most recent being the Kidney Disease: Improving Global Outcomes (KDIGO) Guidelines for Chronic Kidney Disease--Mineral and Bone Disorder (CKD-MBD) (2009). A recently published paper in the Journal of the American Medical Association has been somewhat of a hot topic of discussion by nephrology multidisciplinary teams in rounds, journal clubs and online forums. The article, entitled "Serum levels of phosphorus, parathyroid hormone and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease" (Palmer, Hayen, Macaskill, Pellegrini, Craig, Elder, & Strippoli, 2011) was written by a group of internationally based academic nephrologists and researchers. In an era where clinical practice guidelines are prevalent, the study hypothesis was that the evidence upon which CKD-MBD guidelines are based is poor and that these guidelines are, therefore, not useful in everyday practice. The objective of the project was to assess the existing evidence in the literature through a systematic review and meta-analysis to better understand the association (as demonstrated by published studies) between serum phosphorus, parathyroid hormone (PTH), and calcium levels, and risks of death, cardiovascular mortality, and nonfatal cardiovascular events in CKD patients (Palmer et al., 2011, p. 1119).