KDIGO clinical practice guidelines for the diagnosis, evaluation, prevention, and treatment of mineral and bone disorders in chronic kidney disease

Kidney Disease: Improving Global Outcomes (KDIGO) is an international nonprofit foundation established in 2003 to improve the care and outcomes of kidney disease patients worldwide through coordination of different initiatives to develop and implement clinical practice guidelines. After almost 4 years of intensive work, the mineral and bone disorder of chronic kidney disease guidelines were presented during the American Society of Nephrology Renal Week at the end of 2008, to be finally published in Kidney International, August 2009. In this paper, the main points of the guidelines are discussed: the diagnosis of biochemical, bone, and vascular abnormalities, the treatment targeted at lowering high serum phosphorus, the normalization of serum calcium, and, in dialysis patients, maintaining parathormone levels in the range of 2 to 9 times exceeding the normal limit. Because there are no randomized clinical trials that compare the efficacy and toxicity of different phosphate binders, vitamin D analogs, and calcimimetics, and there is no evidence that these drugs decrease mortality, the KDIGO experts do not make any specific recommendation in regard to these treatments. Finally, the guidelines for treatment of osteoporosis using bisphosphonates, and for evaluation and treatment of bone disease developing after the kidney transplant are presented in this review.