Lalayiannis Alexander D, Soeiro Emilia M D, Moysés Rosa M A, Shroff Rukshana
Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
University College London Great Ormond Street Hospital Institute of Child Health, London, UK.
Pediatr Nephrol. 2024 Mar;39(3):723-739. doi: 10.1007/s00467-023-06109-3. Epub 2023 Aug 25.
Chronic kidney disease (CKD) mineral and bone disorder (MBD) comprises a triad of biochemical abnormalities (of calcium, phosphate, parathyroid hormone and vitamin D), bone abnormalities (turnover, mineralization and growth) and extra-skeletal calcification. Mineral dysregulation leads to bone demineralization causing bone pain and an increased fracture risk compared to healthy peers. Vascular calcification, with hydroxyapatite deposition in the vessel wall, is a part of the CKD-MBD spectrum and, in turn, leads to vascular stiffness, left ventricular hypertrophy and a very high cardiovascular mortality risk. While the growing bone requires calcium, excess calcium can deposit in the vessels, such that the intake of calcium, calcium- containing medications and high calcium dialysate need to be carefully regulated. Normal physiological bone mineralization continues into the third decade of life, many years beyond the rapid growth in childhood and adolescence, implying that skeletal calcium requirements are much higher in younger people compared to the elderly. Much of the research into the link between bone (de)mineralization and vascular calcification in CKD has been performed in older adults and these data must not be extrapolated to children or younger adults. In this article, we explore the physiological changes in bone turnover and mineralization in children and young adults, the pathophysiology of mineral bone disease in CKD and a potential link between bone demineralization and vascular calcification.
慢性肾脏病（CKD）-矿物质与骨异常（MBD）包括一组生化异常（钙、磷、甲状旁腺激素和维生素D）、骨异常（骨转换、矿化和生长）以及骨骼外钙化。矿物质调节异常会导致骨脱矿，与健康同龄人相比，会引起骨痛并增加骨折风险。血管钙化，即血管壁中存在羟基磷灰石沉积，是CKD-MBD范围的一部分，进而导致血管僵硬、左心室肥厚以及极高的心血管死亡风险。虽然生长中的骨骼需要钙，但过量的钙会沉积在血管中，因此需要仔细调节钙的摄入量、含钙药物的使用以及高钙透析液的使用。正常的生理性骨矿化会持续到生命的第三个十年，这比儿童和青少年时期的快速生长要晚很多年，这意味着年轻人的骨骼钙需求量比老年人高得多。关于CKD中骨（脱）矿化与血管钙化之间联系的许多研究都是在老年人中进行的，这些数据不能外推至儿童或年轻人。在本文中，我们探讨了儿童和年轻人骨转换和矿化的生理变化、CKD中矿骨疾病的病理生理学以及骨脱矿化与血管钙化之间的潜在联系。
