Zdenko Killinger, Zuzana Homerová, Lenka Sterančáková, Juraj Payer
Chronic kidney disease is predominantly from the 3rd stage according to K/DOQI classification related to changes of mineral metabolism, bone changes and extraosseal calcifications. Those three components are collectively called as “chronic kidney disease - mineral and bone disorder” and they significantly contribute to the increase of mortality and morbidity in patients with CKD. Biochemical parameters, namely concentrations of calcium, phosphorus, PTH, ALP and vitamin D are recommended to be checked in regular intervals from the 3rd stage of CKD with the shortening of intervals with the decrease of glomerular filtration. Bone changes with low BMD in the 1st up to 3rd stage are treated as primary osteoporosis, since 3rd stage of CKD independently on BMD is marked as renal osteodystrophy. The topical theme is about extraosseal calcifications which rank patients with CKD to patients with the high cardiovascular risk. In the treatment of bone disease in CKD there is necessary a highly individual approach based on the correct interpretation of concentration levels of calcium, phosphorus and vitamin D including the correct assessment of PTH concentration and to it related right correction. Regimen provisions and a diet are the basic condition while targeted medicamentous treatment is significantly dependent on the stage and form of bone afflictions. The examination of mentioned markers helps to correct assessment of bone afflictions, but frequently it is not possible without bone biopsies.