Smjernice za prevenciju, praćenje i liječenje poremećaja koštano-mineralnog metabolizma u bolesnika s kroničnom bubrežnom bolesti

Professional paper - Professional paper

• Title (english): Guidelines for the prevention, monitoring and therapy of chronic kidneydisease-metabolic bone disease in patients with chronic kidney disease
• Author: Nikolina Bašić-Jukić
• Author: Draško Pavlović
• Author: Ružica Šmalcelj
• Author: Hrvojka Tomić-Brzac
• Author: Lidija Orlić
• Author: Josipa Radić
• Author: Božidar Vujičić
• Author: Vesna Lovčić
• Author: Eva Pavić
• Author: Dragan Klarić
• Author: Marijana Gulin
• Author: Goce Spasovski
• Author: Dragan Ljutić
• Author: Davorin Đanić
• Author: Drago Prgomet
• Author: Halima Resić
• Author: Marina Ratković
• Author: Petar Kes
• Author: Sanjin Rački
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Chronic kidney disease (CKD) is a systemic disease with numerous complications associated with increased morbidity and mortality. Chronic kidney disease-metabolic bone disease (CKD-MBD) starts at early stages of CKD with phosphorus accumulation and consequent initiation of numerous events that result with the development of secondary hyperparathyroidism with changes on bones and extraskeletal tissues. The most important and clinically most relevant consequences of CKD-MBD are vascular calcifications which contribute to cardiovascular mortality. Patients with the increased risk for the development of CKD-MBD should be recognized and treated. Prevention is the most important therapeutic option. The first step should be nutritional counseling with vitamin supplementation if necessary and correction of mineral status. Progression of CKD requires more intensive medicamentous treatment with the additional correction of metabolic acidosis and anemia. Renal replacement therapy should be timely initiated, with the adequate dose of dislaysis. Ideally, preemptive renal transplantion should be offered in individuals without contraindication for immunosuppressive therapy.

Abstract (croatian)

Kronična bubrežna bolest (KBB) sistemska je bolest povezana s nizom komplikacija koje naposljetku dovode do povećanog pobolijevanja i smrtnosti bolesnika. Poremećaj koštano-mineralnog metabolizma (CKD-MBD) počinje u ranim stadijima KBB-a nakupljanjem fosfora u organizmu s posljedičnim pokretanjem niza zbivanja koja rezultiraju razvojem sekundarnog hiperparatiroidizma s promjenama na kostima i izvankoštanim tkivima. Najvažnija i klinički najbitnija posljedica CKD-MBD-a jesu vaskularne kalcifikacije koje pridonose povećanju smrtnosti od srčano-krvožilnih bolesti. Potrebno je prepoznati bolesnike s povećanim rizikom od razvoja CKD-MBD-a i terapijski intervenirati. Prevencija je najbolji ­pristup zbrinjavanju bolesnika. Prvi korak u liječenju jest nutritivno savjetovanje uz nadoknadu vitamina i ispravljanje poremećaja minerala. Napredovanjem KBB-a prema završnom stadiju povećava se potreba za medikamentnom terapijom. Istodobno treba liječiti i ostale probleme poput anemije i acidoze. Potrebno je pravodobno započeti s nadomještanjem bubrežne funkcije uz osiguranje odgovarajuće doze dijalize. Idealno je omogućiti preemptivnu transplantaciju u bolesnika koji nemaju kontraindikacija za primjenu imunosupresijske terapije.

• Keywords (english): Bone Diseases, Metabolic/diagnosis; Bone Diseases, Metabolic/etiology; Bone Diseases, Metabolic/prevention & control; Bone Diseases, Metabolic/therapy; Croatia; Disease Progression; Early Diagnosis; Humans; Monitoring, Physiologic/methods; Patient Care Management/methods; Patient Care Management/organization & administration; Renal Insufficiency, Chronic/complications; Renal Insufficiency, Chronic/diagnosis; Renal Insufficiency, Chronic/therapy
• Language: croatian
• Publication type: Professional paper - Professional paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Liječnički vjesnik
• Numbering: vol. 138, no. 5-6, pp. 107-120
• p-ISSN: 0024-3477
• URN:NBN: urn:nbn:hr:105:930449
• Publication: 2016-05
• Document URL: https://hrcak.srce.hr/file/255066
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 09:35:34