TY - JOUR

T1 - Recommended calcium intake in adults and children with chronic kidney disease-a European consensus statement

AU - Evenepoel, Pieter

AU - Jørgensen, Hanne Skou

AU - Bover, Jordi

AU - Davenport, Andrew

AU - Bacchetta, Justine

AU - Haarhaus, Mathias

AU - Hansen, Ditte

AU - Gracia-Iguacel, Carolina

AU - Ketteler, Markus

AU - McAlister, Louise

AU - White, Emily

AU - Mazzaferro, Sandro

AU - Vervloet, Marc

AU - Shroff, Rukshana

N1 - Publisher Copyright: © The Author(s) 2023.

PY - 2024

Y1 - 2024

N2 - Mineral and bone disorders (MBD) are common in patients with chronic kidney disease (CKD), contributing to significant morbidity and mortality. For several decades, the first-line approach to controlling hyperparathyroidism in CKD was by exogenous calcium loading. Since the turn of the millennium, however, a growing awareness of vascular calcification risk has led to a paradigm shift in management and a move away from calcium-based phosphate binders. As a consequence, contemporary CKD patients may be at risk of a negative calcium balance, which, in turn, may compromise bone health, contributing to renal bone disease and increased fracture risk. A calcium intake below a certain threshold may be as problematic as a high intake, worsening the MBD syndrome of CKD, but is not addressed in current clinical practice guidelines. The CKD-MBD and European Renal Nutrition working groups of the European Renal Association (ERA), together with the CKD-MBD and Dialysis working groups of the European Society for Pediatric Nephrology (ESPN), developed key evidence points and clinical practice points on calcium management in children and adults with CKD across stages of disease. These were reviewed by a Delphi panel consisting of ERA and ESPN working groups members. The main clinical practice points include a suggested total calcium intake from diet and medications of 800-1000 mg/day and not exceeding 1500 mg/day to maintain a neutral calcium balance in adults with CKD. In children with CKD, total calcium intake should be kept within the ; on behalf of European Renal Osteodystrophy (EUROD), an initiative of the Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) and the European Renal Nutrition (ERN) Working Groups of the European Renal Association (ERA) and the European Society of Pediatric Nephrology (ESPN) age-appropriate normal range. These statements provide information and may assist in decision-making, but in the absence of high-level evidence must be carefully considered and adapted to individual patient needs.

AB - Mineral and bone disorders (MBD) are common in patients with chronic kidney disease (CKD), contributing to significant morbidity and mortality. For several decades, the first-line approach to controlling hyperparathyroidism in CKD was by exogenous calcium loading. Since the turn of the millennium, however, a growing awareness of vascular calcification risk has led to a paradigm shift in management and a move away from calcium-based phosphate binders. As a consequence, contemporary CKD patients may be at risk of a negative calcium balance, which, in turn, may compromise bone health, contributing to renal bone disease and increased fracture risk. A calcium intake below a certain threshold may be as problematic as a high intake, worsening the MBD syndrome of CKD, but is not addressed in current clinical practice guidelines. The CKD-MBD and European Renal Nutrition working groups of the European Renal Association (ERA), together with the CKD-MBD and Dialysis working groups of the European Society for Pediatric Nephrology (ESPN), developed key evidence points and clinical practice points on calcium management in children and adults with CKD across stages of disease. These were reviewed by a Delphi panel consisting of ERA and ESPN working groups members. The main clinical practice points include a suggested total calcium intake from diet and medications of 800-1000 mg/day and not exceeding 1500 mg/day to maintain a neutral calcium balance in adults with CKD. In children with CKD, total calcium intake should be kept within the ; on behalf of European Renal Osteodystrophy (EUROD), an initiative of the Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) and the European Renal Nutrition (ERN) Working Groups of the European Renal Association (ERA) and the European Society of Pediatric Nephrology (ESPN) age-appropriate normal range. These statements provide information and may assist in decision-making, but in the absence of high-level evidence must be carefully considered and adapted to individual patient needs.

KW - calcium

KW - chronic kidney disease-mineral and bone disorder

KW - osteoporosis

KW - renal insufficiency

KW - vascular calcification

U2 - 10.1093/ndt/gfad185

DO - 10.1093/ndt/gfad185

M3 - Journal article

C2 - 37697718

AN - SCOPUS:85182906204

VL - 39

SP - 341

EP - 366

JO - Nephrology, Dialysis, Transplantation

JF - Nephrology, Dialysis, Transplantation

SN - 0931-0509

IS - 2

ER -