Recommended calcium intake in adults and children with chronic kidney disease-a European consensus statement

Pieter Evenepoel*, Hanne Skou Jørgensen, Jordi Bover, Andrew Davenport, Justine Bacchetta, Mathias Haarhaus, Ditte Hansen, Carolina Gracia-Iguacel, Markus Ketteler, Louise McAlister, Emily White, Sandro Mazzaferro, Marc Vervloet, Rukshana Shroff, European Renal Osteodystrophy (EUROD) workgroup

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

Abstract

Mineral and bone disorders (MBD) are common in patients with chronic kidney disease (CKD), contributing to significant morbidity and mortality. For several decades, the first-line approach to controlling hyperparathyroidism in CKD was by exogenous calcium loading. Since the turn of the millennium, however, a growing awareness of vascular calcification risk has led to a paradigm shift in management and a move away from calcium-based phosphate binders. As a consequence, contemporary CKD patients may be at risk of a negative calcium balance, which, in turn, may compromise bone health, contributing to renal bone disease and increased fracture risk. A calcium intake below a certain threshold may be as problematic as a high intake, worsening the MBD syndrome of CKD, but is not addressed in current clinical practice guidelines. The CKD-MBD and European Renal Nutrition working groups of the European Renal Association (ERA), together with the CKD-MBD and Dialysis working groups of the European Society for Pediatric Nephrology (ESPN), developed key evidence points and clinical practice points on calcium management in children and adults with CKD across stages of disease. These were reviewed by a Delphi panel consisting of ERA and ESPN working groups members. The main clinical practice points include a suggested total calcium intake from diet and medications of 800-1000 mg/day and not exceeding 1500 mg/day to maintain a neutral calcium balance in adults with CKD. In children with CKD, total calcium intake should be kept within the ; on behalf of European Renal Osteodystrophy (EUROD), an initiative of the Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) and the European Renal Nutrition (ERN) Working Groups of the European Renal Association (ERA) and the European Society of Pediatric Nephrology (ESPN) age-appropriate normal range. These statements provide information and may assist in decision-making, but in the absence of high-level evidence must be carefully considered and adapted to individual patient needs.

OriginalsprogEngelsk
TidsskriftNephrology Dialysis Transplantation
Vol/bind39
Nummer2
Sider (fra-til)341-366
Antal sider26
ISSN0931-0509
DOI
StatusUdgivet - feb. 2024

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