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INVITED REVIEWS |
Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
Correspondence to: C.P. Schmitt, Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Im Neuenheimer Feld 151, Heidelberg 69120 Germany. claus.peter.schmitt{at}med.uni-heidelberg.de
Control of mineral homeostasis is a particularly challenging task in
children and adolescents on dialysis. Treatment efforts must not only ensure
patient survival and the absence of debilitating complications of bone
disease, but in view of a potentially long lifespan, must also consider how to
best promote long-term cardiovascular health and successful psychosocial
transition into adult life. In that context, avoidance of cardiovascular
calcifications and accomplishment of adequate statural growth and a normal
final height are major objectives of uremic bone disease management in
children. Unfortunately, current pediatric management guidelines operate on a
small evidence base, and major controversy surrounds key issues such as
optimal target ranges for serum parathyroid hormone, calcium, and phosphorus
in the individual childhood phases, and individual risk–benefit ratios
for the use of phosphate binders, vitamin D analogs, and calcimimetics in
children. The present review summarizes the current state of knowledge and
outlines future research requirements in bone disease associated with
pediatric end-stage renal disease.
KEY WORDS: Mineral homeostasis; children; CKD; growth.
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