Drs Sharon Moe and Stephen Fadem selected a timely and important topic for this issue: chronic kidney disease mineral bone disorder. Just when we think we have something figured out, the treatment of bone and mineral disorders in chronic kidney disease (CKD), we realize we have put our foot in it. Patients with CKD and end-stage renal disease (ESRD) are living long enough to suffer the complications of “old” therapies that will lead us to seek “new” therapies, always trying to stay one step ahead. The first article in this important series by Drs Moe, Drueke, Lameire, and Eknoyan describes the newly minted terminology of chronic kidney disease mineral bone disorder (CKD-MBD). Eric Young then looks at mineral metabolism and mortality in patients with CKD. Drs Thadhani and Wolf explore the potential role of vitamin D in patients with secondary hyper parathyroidsim.
Drs Gal-Moscovici and Sprague describe diagnosis and screening of CKD-MBD and look at biomarkers and imaging techniques in the diagnosis of bone disorders. They also discuss regulation of bone metabolism in CKD and effects of various hormones including morphologic presentation. Drs Raggi and Bellasi discuss the clinical assessment of vascular calcification in CKD, with an emphasis on cardiovascular calcification and the threat of increased cardiovascular events in this population. Drs Fadem and Moe describe the current management of CKD-MBD, which has become quite complex. And, finally, Drs El-Abbadi and Giachelli discuss mechanisms of vascular calcification. Linda McCann contributed an article to the Nutrition section that looks at the role of calcium in CKD with an emphasis on recommended intake and serum targets.
Our Public Policy article, by Dr Williams, focuses on the significant uninsured population with ESRD in the United States and the many issues faced by patients and providers. Dolph Chianchiano looks at the Medicare and CKD care on the third anniversary of the Medicare Modernization Act of 2003 (Public Law 109-173). There appear to be many loop holes and missed opportunities for the patient with CKD.
We also have 3 Wildcard articles in this issue. Drs Murtagh, Addington-Hall, and Higginson provide an extremely extensive review of symptom prevalence in ESRD that provides a rationale for further research in a neglected field and a challenge to explore dialysis and CKD-related symptoms and treatments. Dr Kleinpeter writes a timely piece on provision of care for ESRD patients in hurricane prone areas, with firsthand experience with Hurricane Katrina. And, finally, Dr Batlle’s group has an important article that addresses stabilization of CKD in a cohort of stage 4 and stage 5 CKD patients, those on the most slippery part of the slope of CKD.
Welcome to a new year. Our best wishes for a happy and healthy year blessed with productive work and a balanced life!
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