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Battleground: Chronic Kidney Disorders Mineral and Bone Disease—Calcium Obsession, Vitamin D, and Binder Confusion

Csaba P. Kovesdy^*,, Rajnish Mehrotra, and Kamyar Kalantar-Zadeh

^* Division of Nephrology, Salem Veterans Affairs Medical Center, Salem Virginia; Department of Medicine, University of Virginia, Charlottesville, Virginia; and Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

Correspondence and Reprint Requests to: Dr. Csaba P. Kovesdy, Salem VA Medical Center, Division of Nephrology, 1970 Roanoke Boulevard, Salem, VA 24153. Phone: 540-982-2463; Fax: 540-224-1963; E-mail: csaba.kovesdy{at}va.gov

Renal osteodystrophy is a significant complication in chronic kidney disease. This condition is referred to as mineral and bone disorders in chronic kidney disease, mainly because of its wider ranging impact, including an association with increased mortality and non–bone-related morbidity. Because most of the abnormalities that characterize mineral and bone disorders in chronic kidney disease (e.g., hyperphosphatemia, secondary hyperparathyroidism) are amenable to therapeutic interventions, this field has also been in the cross-hairs of many pharmaceutical companies. The advent of a number of new therapeutic options for mineral and bone disorders in chronic kidney disease has broadened our armamentarium but has also resulted in an intense marketing battle between pharmaceutical companies. The paucity of randomized, controlled trials in this field has allowed the various companies to promote unilaterally data that fit their needs and to attempt to discredit data that support their competitors’ products. Although this attitude is expected and regarded as acceptable in a consumer society, on a scientific level, it has resulted in a polarized and often confused audience: The practicing nephrologists. This article provides a historical overview of how the field of mineral and bone disorders in chronic kidney disease has evolved from a pharmaceutical standpoint, with a critical emphasis of the key moments that resulted in the current acrimonious climate. Also assessed is what the key unanswered questions are in this field, and practical solutions to the discussed issues are provided.

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				C. S Shinaberger, S. Greenland, J. D Kopple, D. Van Wyck, R. Mehrotra, C. P Kovesdy, and K. Kalantar-Zadeh Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease? Am. J. Clinical Nutrition, December 1, 2008; 88(6): 1511 - 1518. [Abstract] [Full Text] [PDF]

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