Adaptation and Implementation of the "Kidney Disease: Improving Global Outcomes (KDIGO)" Guidelines for Evaluation and Management of Mineral and Bone Disorders in Chronic Kidney Disease for Practice in the Middle East Countries

Abstract

This review presents the views of an expert group of nephrologists from the Middle East along with an international expert on adaptation and implementation of the 2009 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for evaluation and manage-ment of mineral and bone disorders in chronic kidney disease (CKD-MBD) for practice in the Middle East countries. The members of the panel examined the KDIGO guidelines and formulated recommendations that can be implemented practically for the management of CKD-MBD in the Middle East. There was a broad agreement on most of the recommendations made by the KDIGO work-group. However, the panelists commented on specific areas and amplified certain concepts that might help the nephrologists in the Middle East. The final document was reviewed by all participants as well as by members of the Middle East task force implementation group for KDIGO guidelines. Their comments were incorporated. The guideline statements are presented along with detailed rationale and relevant discussion as well as limitations of the evidence. The panel recognized the need to upgrade the suggestion of KDIGO related to lateral abdominal radiograph and echocardiogram in patients with CKD stages 3-5D into a stronger recommendation. The panel underlined the risk of hyper-phosphatemia to CKD-MBD and the importance of prompt initiation or modification of therapy according to rising trends in para-thyroid hormone level. They recommended the use of non-calcium-based phosphate binders as the first-line therapy in CKD patients with signs of vascular calcification. The panel agreed that all aspects of the KDIGO recommendations concerning bone biopsy, evaluation and treatment of bone disease after kidney trans-plantation should be implemented as such.

Pattern of Laboratory Parameters and Management of Secondary Hyperparathyroidism in Countries of Europe, Asia, the Middle East, and North America

“…For example, a survey of medical directors of dialysis centers in Saudi Arabia [41] revealed opportunities to increase understanding of SHPT management. A committee of nephrologists from the Middle East subsequently reviewed the 2009 KDIGO guidelines for the management of CKD-MBD [14] to formulate practical, standardized regional recommendations [1]. Encouragingly, an analysis of the management of patients undergoing hemodialysis in Saudi Arabia from 2011 to 2013 found trends over time for better utilization of drugs and improvement in laboratory parameters [42].…”

“…The prevalence of chronic kidney disease (CKD), including progression to CKD stage 5, is increasing globally, including in the Middle East [ 1 – 4 ], China [ 5 ], and Russia [ 6 ], presumably due to rising prevalence of diabetes and hypertension [ 7 – 9 ]. More patients with CKD in resource-limited countries are expected to receive dialysis in the future, despite current gaps between need and availability in lower-income countries [ 10 ].…”

FGF23 neutralization improves bone quality and osseointegration of titanium implants in chronic kidney disease mice

“…Chronic kidney disease (CKD) has become a worldwide health problem with rapidly growing prevalence 1 . A previous cross-sectional survey in Chinese and Bangladesh adults showed that the overall prevalence of CKD was 10.8% and 26%, respectively 2 3 .…”

Use of 99mTc-sestamibi SPECT/CT imaging in predicting the degree of pathological hyperplasia of the parathyroid gland: semi-quantitative analysis

“…During the operation, all PGs of the patients were explored and resected, and the partial PGs with the lowest degree of hyperplasia were selected and cut into 1 mm 3 . Two sites were selected for autotransplantation in the forearm muscles of the non-fistula hand (5,15,16). Tc-MIBI scintigraphy 99m Tc-MIBI scintigraphy was performed using a SPECT/ CT scanner (GE Medical Systems, 670, Tirat Hacarmel, Israel) after intravenous administration of 740 MBq 99m Tc-MIBI (Figures 1,2).…”