How is CKD-MBD diagnosed?To diagnos

How is CKD-MBD diagnosed?
To diagnose CKD-MBD, a doctor may take a blood sample to measure levels of calcium, phosphorus, PTH, and sometimes vitamin D. The doctor may perform a bone biopsy to see if the bone cells are building normal bone. A bone biopsy is done under local anesthesia and involves removing a small sample of bone from the hip and analyzing it with a microscope. Determining the cause of CKD-MBD helps the doctor decide on a course of treatment.

How is CKD-MBD treated?
Controlling PTH levels prevents damage to bones. Usually, overactive parathyroid glands are controllable with a change in diet, dialysis treatment, or medication.
CKD-MBD can be treated with changes in diet. Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease. Almost all foods contain phosphorus, but it is especially high in milk, cheese, dried beans, peas, nuts, and peanut butter. Drinks such as cocoa, dark sodas, and beer are also high in phosphorus. Often, medications called phosphate binders—such as calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer hydrochloride (Renagel), or lanthanum carbonate (Fosrenol)—are prescribed with meals and snacks to bind phosphorus in the bowel. These medications decrease the absorption of phosphorus into the blood. A renal dietitian can help develop a dietary plan to control phosphorus levels in the blood.
These medications decrease the absorption of phosphorus into the blood.
Increasing dialysis dose by increasing a patient’s flow rate or time in treatment can also help control phosphorus.
If the kidneys are not making adequate amounts of calcitriol, a person can take synthetic calcitriol as a pill (Rocaltrol) or in an injectable form (Calijex). Other types of vitamin D that may be prescribed are ergocalciferol (Calciferol, Drisdol), cholecalciferol (Delta D3), doxercalciferol (Hectoral), and paricalcitol (Zemplar). A doctor may prescribe a calcium supplement in addition to calcitriol. The drug cinacalcet hydrochloride (Sensipar), approved by the U.S. Food and Drug Administration in 2004, lowers PTH levels by imitating calcium’s effects on the parathyroid gland. If PTH levels cannot be controlled, the parathyroid glands may need to be removed surgically.
A good treatment program, including proper attention to diet, dialysis, and medications, can improve the body’s ability to repair bones damaged by CKD-MBD. Overall bone health can also be improved by exercising and not smoking. People on dialysis should consult a health care professional before beginning any exercise program.