The Use of Imaging Techniques in Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBD)—A Systematic Review

Abstract

Although frequently silent, mineral and bone disease (MBD) is one of the most precocious complication of chronic kidney disease (CKD) and is omnipresent in patients with CKD stage 5. Its pathophysiology is complex, but basically, disturbances in vitamin D, phosphate, and calcium metabolism lead to a diverse range of clinical manifestations with secondary hyperparathyroidism usually being the most frequent. With the decline in renal function, CKD-MBD may induce microstructural changes in bone, vascular system and soft tissues, which results in macrostructural lesions, such as low bone mineral density (BMD) resulting in skeletal fractures, vascular and soft tissue calcifications. Moreover, low BMD, fractures, and vascular calcifications are linked with increased risk of cardiovascular mortality and all-cause mortality. Therefore, a better characterization of CKD-MBD patterns, beyond biochemical markers, is helpful to adapt therapies and monitor strategies as used in the general population. An in-depth characterization of bone health is required, which includes an evaluation of cortical and trabecular bone structure and density and the degree of bone remodeling through bone biomarkers. Standard radiological imaging is generally used for the diagnosis of fracture or pseudo-fractures, vascular calcifications and other features of CKD-MBD. However, bone fractures can also be diagnosed using computed tomography (CT) scan, magnetic resonance (MR) imaging and vertebral fracture assessment (VFA). Fracture risk can be predicted by bone densitometry using dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QTC) and peripheral quantitative computed tomography (pQTC), quantitative ultrasound (QUS) and most recently magnetic resonance micro-imaging. Quantitative methods to assess bone consistency and strength complete the study and adjust the clinical management when integrated with clinical factors. The aim of this review is to provide a brief and comprehensive update of imaging techniques available for the diagnosis, prevention, treatment and monitoring of CKD-MBD.

Vitamin D deficiency as risk factor associated with anemia and outcome hemodialysis patients

“…Vt.D deficiency is prevalent in patients with CKD receiving hemodialysis. The reason for deficiency of vitamin D in these patients is multifactorial; inactivity of patients undergoing replacement therapy and Regardless of whether patients have undergone dialysis, Vt.D deficiency is associated with effects related to frailty and sarcopenia in those with chronic kidney disease (CKD); such effects include low bone density (Pimentel et al;2021), muscle strength and falls (Gunton and Girgis, 2018), and cognitive and dementia impairment (Chai et al;. Moreover, VT.D deficiency has been many related to many infections, such as tuberculosis, seasonal influenza (Zisi et al;2019, Grant et al;, and novel COVID 2019, as well as increased mortality (Wang et al;.…”

Circulating p-Cresyl Sulfate, Non-Hepatic Alkaline Phosphatase and Risk of Bone Fracture Events in Chronic Kidney Disease-Mineral Bone Disease

“…BF events in CKD-MBD stand for the toughest complications that increase the risk of subsequent high rates of hospitalization and mortality dramatically [ 15 , 16 , 17 , 18 ]. However, none of the prior research investigated the association between PCS, NHALP and BF events.…”

Fat-Bone Relationship in Chronic Kidney Disease—Mineral Bone Disorders: Adiponectin Is Associated with Skeletal Events among Hemodialysis Patients

“…High morbidity and mortality rates correlate tightly with progressive CKD-MBD that are intricately involved in underlying metabolic bone alterations and bone marrow microenvironment (e.g., adipocytes, mesenchymal stem cells, osteoblasts and osteoclasts) [ 10 , 17 , 18 , 19 , 20 ]. Adipocytes in bone marrow, or termed marrow adipose tissue, reside in the bone microenvironment in close contact to all types of bone cells.…”

“…Adipocytes in bone marrow, or termed marrow adipose tissue, reside in the bone microenvironment in close contact to all types of bone cells. From bedside to bench, the relationship between the fat-bone axis and osteoporotic BF events is evident [ 10 , 17 , 18 , 19 , 20 ]. Despite these molecular connections between fat and bone, none of the prior research investigated the association between CKD-MBD and the fat-bone axis.…”