Chronic kidney disease–mineral and bone disorder

Clinical information

Chronic kidney disease (CKD) is an important public health problem affecting 5% to10% of the world’s population with growing global burden. CKD is defined as abnormalities in kidney structure or function (or both) that are present for more than three months and have health implications. The disease is further classified based on cause, glomerular filtration rate (GFR) and extent of albuminuria. As kidney function decreases, marked changes in bone and mineral metabolism occur, leading to a constellation of bone lesions referred to as renal osteodystrophy (ROD). Chronic kidney disease–mineral and bone disorder (CKD–MBD) is a systemic disorder characterised by a combination of:

biochemical abnormalities – including calcium, phosphate, PTH, or vitamin D metabolism disorders;
bone abnormalities – in turnover, mineralization, volume, or strength; and,
vascular calcification

These three interrelated processes account for the morbidity and mortality in CKD; therefore, early recognition is essential to initiate appropriate management.

Diagnostics

The biochemical, hormonal and mineral irregularities, bone disorders and extraskeletal calcification should all be addressed for the diagnosis and management of CKD–MBD.

Treatment decisions should not be based on a single laboratory value but on trending of serial measurements of phosphate, calcium and PTH considered together, as therapy for one abnormality could also affect others. 25(OH)D levels might be measured with repeated assessments depending on baseline values and therapeutic interventions.

Bone biopsy is the gold standard for CKD-associated osteoporosis in CKD patients; however, the procedure is invasive and cumbersome. Recent studies have indicated that the use of certain bone turnover markers (BTMs) may prove beneficial to assess bone turnover and support monitoring of CKD–MBD therapies. Due to the reduction in kidney function, it is important to use markers of bone turnover that are not excreted by the kidneys such as:

bone alkaline phosphatase (BAP)
intact propeptide of type I collagen (PINP) and
tartrate-resistant acid phosphatase 5b (TRAcP 5b).

Matrix γ-carboxyglutamatic acid (Gla) protein, or matrix Gla protein (MGP) for short, is one of the most well-known inhibitors of vascular and tissue calcification. Increased dephosphorylated-uncarboxylated MGP (dp-ucMGP) levels are considered a risk marker for cardiovascular diseases. Regular monitoring of the dp-ucMGP level may help to assess the risk of vascular complications in elderly people who are prone to atherosclerosis as well as in CKD patients.

Methods

ChLIA (15)

ELISA (6)

Technology	Parameter	Substrate	Species	Calibration	Format	Order No.
ELISA	Ostase® BAP EIA Bone-specific alkaline phosphatase	antibody coated microtiter wells	Bone-specific alkaline phosphatase		96 x 01	AC-20F1¹
ELISA	BoneTRAP® (TRAcP 5b) ELISA Tartrate-resistant acid phosphatase	antibody coated microtiter wells	Tartrate-resistant acid phosphatase		96 x 01	SB-TR201A¹
ChLIA	IDS Ostase® BAP	Streptavidin-coated magnetic particles		quantitative	100 x 01	IS-2800¹
ChLIA	IDS Ostase® BAP Control Set	2 x 2.5 ml Control 1/2/3	Bone alkaline phosphatase (BAP)		3 concentration levels	IS-2830¹
ChLIA	IDS Intact PINP	Streptavidin-coated magnetic particles		quantitative	100 x 01	IS-4000¹
ChLIA	IDS Intact PINP Control Set	2 x 1.0 ml Control 1/2/3	Procollagen type I N-propeptide (PINP)		3 concentrations	IS-4030¹
ChLIA	IDS TRAcP 5b (BoneTRAP®) Control Set	3 x 1.0 ml Control 1/2/3	Tartrate-resistant acid phosphatase 5b (TRAP 5b)		3 concentration levels	IS-4130¹
ChLIA	IDS InaKtif MGP (dp-uc MGP)	Streptavidin-coated magnetic particles		quantitative	100 x 01	IS-4700¹
ChLIA	IDS InaKtif MGP (dp-uc MGP) Control Set	4 x 1.0 ml Control 1/2/3	dephosphorylated-uncarboxylated matrix Gla protein (dp-uc MGP)		3 concentration levels	IS-4730¹
ELISA	1,25-Dihydroxy Vitamin D EIA	antibody coated microtiter wells	1,25-(OH)2 vitamin D		96 x 01	AC-62F1¹
ChLIA	IDS 1,25 VitD Xp	Streptavidin-coated magnetic particles		quantitative	100 x 01	IS-2000¹
ChLIA	IDS 1,25 VitD Xp Control Set	6 x 1.2 ml Control 1/2	1,25-dihydroxyvitamin D		2 concentration levels	IS-2030¹
ChLIA	IDS 1,25-Dihydroxy Vitamin D	Streptavidin-coated magnetic particles		quantitative	100 x 01	IS-2400¹
ChLIA	IDS 1,25-Dihydroxy Vitamin D Control Set	3 x 1.2 ml Control 1/2	1,25-dihydroxyvitamin D		2 concentration levels	IS-2430¹
ELISA	25-Hydroxy Vitamin D S EIA (D2 and D3)	antibody coated microtiter wells	25-OH vitamin D (D2 and D3)		96 x 01	AC-57SF1¹
ELISA	25-OH-Vitamin D ELISA	antibody-coated microplate wells	25-OH vitamin D (D2 and D3)	0/4/10/25/60/120 ng/ml	96 x 01	EQ 6411-9601
ELISA	Intact-PTH ELISA	antibody-coated microplate wells	Recombinant human parathormone (1-84)	0-500 pg/ml	96 x 01	EQ 6421-9601
ChLIA	IDS 25 VitD S	Streptavidin-coated magnetic particles		quantitative	100 x 01	IS-2500N¹
ChLIA	IDS 25 VitD S Calibrator Set	1 x 1.0 ml Calibrator 1/2/3/4/5/6	25-hydroxyvitamin D		6 concentration levels	IS-2520N¹
ChLIA	IDS 25 VitD S Control Set	3 x 2.5 ml Control 1/2	25-hydroxyvitamin D		2 concentration levels	IS-2530N¹
ChLIA	IDS Intact PTH Control Set	6 x 1.0 ml Control 1/2/3	Parathyroid hormone (PTH), intact		3 concentration levels	IS-3230¹
* For research use only, not for in vitro diagnostic use in the sense of EU directive 98/79/EC. ¹ Product manufactured by third party. Please contact your local Euroimmun representative for more information.