Childhood and adolescence are crucial times for the development of a healthy skeletal and cardiovascular system. Disordered
mineral and bone metabolism accompany
chronic kidney disease (CKD) and present significant obstacles to optimal bone strength, final adult height, and cardiovascular health. Decreased activity of renal 1 alpha
hydroxylase results in decreased intestinal
calcium absorption, increased serum
parathyroid hormone levels, and high-turnover
renal osteodystrophy, with subsequent growth failure. Simultaneously,
phosphorus retention exacerbates
secondary hyperparathyroidism, and elevated levels contribute to
cardiovascular disease. Treatment of
hyperphosphatemia and
secondary hyperparathyroidism improves growth and high-turnover bone disease. However, target ranges for serum
calcium,
phosphorus, and
parathyroid hormone (PTH) levels vary according to stage of CKD. Since over-treatment may result in adynamic
bone disease, growth failure,
hypercalcemia, and progression of cardiovascular calcifications,
therapy must be carefully adjusted to maintain optimal serum biochemical parameters according to stage of CKD. Newer therapeutic agents, including
calcium-free
phosphate binding agents and new
vitamin D analogues, effectively suppress serum PTH levels while limiting intestinal
calcium absorption and may provide future therapeutic alternatives for children with CKD.