Chronic kidney disease metabolic bone disorder chuyển hóa

Healthy kidneys do many important jobs. They remove wastes and extra fluid from your body, help make red blood cells, and help keep bones strong. They also help to keep the right amount of minerals in your blood. Minerals are nutrients that your body needs to stay healthy.

When you have kidney disease or kidney failure, your kidneys cannot do these important jobs well. As a result, you may develop mineral and bone disorder. It is a common problem in people with kidney disease, and it affects almost everyone with kidney failure.

What is mineral and bone disorder?

Mineral and bone disorder related to kidney disease happens when there is an imbalance in your blood levels of calcium and phosphorus. This mineral imbalance can affect your bones, heart and blood vessels.

How does kidney disease and kidney failure lead to bone and heart disease?

When too much kidney function is lost, your kidneys can no longer filter out extra phosphorus and remove it from the body in the urine. Over time, phosphorus from the foods you eat can build up to high levels in your blood.

Healthy kidneys also change vitamin D from sunlight and the foods you eat into active vitamin D that your body can use. When kidneys fail there is a short supply of active vitamin D. This causes calcium and phosphorus to get out of balance.

When the blood phosphorus level goes up and blood vitamin D level goes down, your body makes too much parathyroid hormone (PTH). High PTH levels cause calcium to move from your bones into your blood. As calcium leaves your bones they become weaker, more brittle, and are more likely to break. Some calcium may also end up in the heart and blood vessels. This may cause or worsen heart disease.

What are the signs and symptoms of mineral and bone disorder?

Mineral and bone disorder can cause you to have:

• Itchy skin
• Bone pain
• Weak bones that break easily
• Blocked blood vessels
• Heart problems
• Anemia
• Nerve problems
• Difficulty fighting off germs

How do I know if I have mineral and bone disorder?

• You will have blood tests to check your blood levels of calcium, phosphorus, PTH and vitamin D.
• Some people may need to have a bone biopsy. A bone biopsy is a sample of bone taken for study.
• Your healthcare provider may order an x-ray of your abdomen, or an echocardiogram of your heart to check if mineral imbalance has affected your heart and blood vessels.

How do you treat mineral and bone disorder?

Many people with kidney disease or kidney failure need treatment for high blood phosphorus or PTH levels. Your healthcare provider will order the treatment that is right for you.

• Lower phosphorus diet Eating a lower phosphorus diet helps to keep your blood phosphorus in the right range. Speak with your kidney dietitian on ways to limit dietary phosphorus intake.
• Phosphate binders Phosphate binders and phosphate absorption inhibitors are medicines that help to keep blood phosphorus levels under control.
• Vitamin D Your body needs the active form of vitamin D. Your healthcare provider will decide which type of vitamin D medicine is right for you
• Calcimimetics Calcimimetcs are medicines often used when blood PTH, calcium and phosphorus levels are too high in people on dialysis.
• Calcium supplements Speak to your healthcare provider before taking a calcium supplement. The results of your blood tests will help show if you need to take extra calcium.
• Surgery Some people with high PTH levels need surgery to remove some or all of the parathyroid gland.
• Exercise The exercises that may be most helpful are called strengthening and weight-bearing exercise. Check with your healthcare provider before starting an exercise program.

To read more about mineral and bone disorder, click here.

Reviewed June, 2014

If you would like more information, please contact us.

© 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.

Metabolic syndrome is a cluster of risk factors that together increase a person's risk of stroke, heart disease and type 2 diabetes. These risk factors are:

• high blood pressure
• excess abdominal weight
• low levels of ‘good’ cholesterol (HDL cholesterol)
• insulin resistance, where your cells don't respond to insulin and your blood sugar levels rise

Metabolic syndrome is also known as syndrome X or insulin-resistance syndrome.

People with metabolic syndrome have 2 to 3 times the risk of having a heart attack and stroke, type 2 diabetes or chronic kidney disease than people without the condition.

Metabolic syndrome affects many adults in Australia, and can also affect children and adolescents.

What are the symptoms of metabolic syndrome?

Some of the disorders that contribute to metabolic syndrome have obvious signs and symptoms, but others (such as high blood pressure and high cholesterol) do not,

A build-up of fat around the waist is a sign of the risk of metabolic syndrome. This is known as abdominal obesity or central obesity. It can be diagnosed by measuring a person’s waist circumference. Anything over the recommended threshold qualifies as abdominal obesity. Your doctor can measure your waist circumference for you. The thresholds differ for men and women, and also for different ethnicities.

High blood sugar, resulting from insulin resistance, may lead to symptoms of type 2 diabetes such as increased thirst and urination, fatigue, and blurred vision.

What causes metabolic syndrome?

The elements that contribute to metabolic syndrome are influenced by lifestyle factors, such as diet and physical activity, and also by genetics. A sedentary lifestyle with a poor diet is thought to be the most common cause of metabolic syndrome.

How is metabolic syndrome diagnosed?

A person may be diagnosed with metabolic syndrome if they have at least 3 of the following:

• high waist circumference
• raised level of triglycerides, which are a type of fat in the blood
• high blood pressure
• low levels of HDL cholesterol (good cholesterol)
• type 2 diabetes or insulin resistance (increased blood sugar after fasting)

What is the treatment for metabolic syndrome?

Treatment of metabolic syndrome is focussed on the same lifestyle measures that can help prevent it in the first place.

These recommended lifestyle measures include:

• maintaining a healthy weight or losing weight if you need to — which should improve insulin resistance, lower blood pressure and improve cholesterol levels
• exercising for 30 to 60 minutes on most days — this will help reduce weight, improve cholesterol and blood glucose levels and help lower blood pressure (anyone new to exercise should check with their doctor before starting)
• eating well, by reducing kilojoule intake if you are overweight, reducing saturated fat and salt and increasing whole grains, fruits and vegetables — this helps with weight loss, improves cholesterol levels and reduces the risk of type 2 diabetes
• stopping smoking, as smoking increases the risk of metabolic syndrome

In children and adolescents, lifestyle changes like reducing screen time and increasing sport can reduce the risk of developing metabolic syndrome later in life.

Are there any medicines to treat metabolic syndrome?

There are no medicines specifically to treat metabolic syndrome, but you may need medicines to treat some of the contributing conditions, such as high blood pressure or high cholesterol.

Can metabolic syndrome be prevented?

A healthy lifestyle is the most powerful way to prevent metabolic syndrome.

All of the risk factors associated with metabolic syndrome tend to make the other risk factors worse. For example, being overweight can lead to insulin resistance; insulin resistance can worsen your cholesterol levels, and also lead to high blood pressure.

Improving your lifestyle (see below), in terms of physical activity, diet, and being a healthy weight, can help prevent these risk factors or delay their development.

What to do if you think you have metabolic syndrome?

If you think you might have metabolic syndrome, it is important to see your doctor. Medication and lifestyle modification can treat metabolic syndrome and reduce the risk of developing heart disease, stroke, type 2 diabetes and chronic kidney disease.

Your doctor can measure and assess your waist circumference, take your blood pressure and organise for blood tests to measure your cholesterol and triglycerides and blood sugar levels. They can also comprehensively measure your risk of diabetes and heart disease.

Lifestyle modification can treat metabolic syndrome and reduce the risk of developing heart disease, stroke, type 2 diabetes and chronic kidney disease. Medications may also help treat some of the individual risk factors that make up metabolic syndrome, such as high blood pressure and poor cholesterol levels.

Your doctor can advise you on appropriate lifestyle changes and may refer you to a dietitian or exercise physiologist.