Bone metabolism and disease in chronic kidney disease Garabed Eknoyan, MD, Adeera Levin, MD, Nathan W Levin, MD  American Journal of Kidney Diseases  Volume 42, Pages 1-201 (October 2003) DOI: 10.1016/S0272-6386(03)00905-3

Algorithm 1 Vitamin D supplementation in CKD (Stages 3 and 4). American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 2 Management of CKD patients (Stages 3 and 4) with active Vitamin D sterols. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 3 Managing Vitamin D sterols based on serum calcium levels. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 4 Managing Vitamin D sterols based on serum phosphorus levels. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 5 Managing Vitamin D sterols based on intact PTH levels. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 6 Evaluation of aluminum neurotoxicity. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 7 Evaluation of aluminum-related disorders: considerations for DFO test and subsequent DFO treatment. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 8 DFO treatment after PAl rise ≥300 μg/L. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 9 DFO treatment after PAl rise between 50 and 300 μg/L. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 2 Changes in total serum calcium and inorganic phosphorus observed in 11 uremic patients before and after subtotal parathyroidectomy. Reproduced with permission.16 American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 1 Pathogenesis of abnormalities in mineral metabolism and bone disease in CKD. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 3 Example of Summary ROC analysis. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 4 Graph showing relationship between serum I-PTH levels and CCR based on data extracted from Martinez et al (1997). Values on the y-axis are serum I-PTH levels (pg/mL). Values on the x-axis are CCR in mL/min. The lines fitted to the data set are based on 4 different mathematical functions (power, linear, exponential, and logarithmic), rather than on any assumptions about an underlying physiological mechanism. The horizontal line represents the upper limit of the normal range of serum I-PTH levels. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 5 Summary ROC derived from 4 individual studies assessing the diagnostic characteristics of erosions on X-ray for diagnosis of osteitis fibrosa. Values on the y-axis are the diagnostics sensitivity and values on the x-axis are the diagnostics specificity. The more effective the test is as a diagnostic, the closer it falls to the upper left hand corner of the graph. The summary ROC curve and its 95% confidence interval provides a summary estimate of the performance of the test based on the meta-analytically combined results from all 4 studies. The mean threshold (indicated on the graph by a diamond icon) is the best point estimate of the sensitivity and specificity of erosions on X-ray for diagnosis of osteitis fibrosa. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 6 Graph showing relationship between prevalence of osteoporosis as a function of GFR based on data extracted from Rix et al (1999). Values on the y-axis are the prevalence of osteoporosis as defined by a T-Score less than −2.5. Values on the x-axis are midpoint values of GFR in mL/min. The lines fitted to each data set are empirical fits and are not based on any assumptions about an underlying physiological mechanism. Reproduced with permission.31 American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 7 Summary ROC derived from 5 individual studies assessing the diagnostic characteristics of iPTH levels for the diagnosis of high-turnover bone disease. Values on the y-axis are the diagnostic sensitivity and values on the x-axis are the diagnostic specificity. The more effective the test is as a diagnostic tool, the closer it falls to the upper left hand corner of the graph. The summary ROC curve and its 95% CI provide a summary estimate of the performance of the test based on the meta-analytically combined results from all 5 studies. The mean threshold (indicated in the graph by a diamond icon) is the best point estimate of the sensitivity and specificity of iPTH levels for the diagnosis of high-turnover bone disease. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 8 Summary ROC derived from 5 individual studies assesing the diagnostic characteristics of iPTH levels for the diagnosis of low-turnover bone disease. Values on the y-axis are the diagnostic sensitivity and values on the x-axis are the diagnostic specificity. The more effective the test is as a diagnostic, the closer it falls to the upper left hand corner of the graph. The summary ROC curve and its 95% CI provides a summary estimate of the performance of the test based on the meta-analytically combined results from all 5 studies. The mean threshold (indicated in the graph by a diamond icon) is the best point estimate of the sensitivity and specificity of iPTH levels for the diagnosis of low-turnover bone disease. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 9 Relationship between serum phosphorus and CCR. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 10 Meta-analysis of size of effect on serum phosphorus levels of calcium acetate versus calcium carbonate. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 11 Meta-analysis of size of hypercalcemic effect of calcium carbonate versus other phosphate binders. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 1 Vitamin D supplementation in CKD (Stages 3 and 4). American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 2 Management of CKD patients (Stages 3 and 4) with active Vitamin D sterols. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 3 Managing Vitamin D sterols based on serum calcium levels. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 4 Managing Vitamin D sterols based on serum phosphorus levels. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 5 Managing Vitamin D sterols based on intact PTH levels. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 12 Meta-analysis of oral versus intravenous calcitriol on PTH suppression. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 13 Summary odds ratio of being diagnosed with Aβ2M over time on dialysis. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 6 Evaluation of aluminum neurotoxicity. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 7 Evaluation of aluminum-related disorders: considerations for DFO test and subsequent DFO treatment. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 8 DFO treatment after PAl rise ≥300 μg/L. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 9 DFO treatment after PAl rise between 50 and 300 μg/L. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 14 Individual study and summary effect sizes for the effect of DFO therapy on bone formation rate. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 15 Individual study and summary effect sizes for the effect of DFO therapy on bone surface aluminum stain. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Fig 16 Effect sizes and 95% CI of RCTs and retrospective studies reporting incidence of necrosis. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 10 CKD Stages 3 and 4. American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

Algorithm 11 CKD Stage 5 (on dialysis). American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)

American Journal of Kidney Diseases 2003 42, 1-201DOI: (10 American Journal of Kidney Diseases 2003 42, 1-201DOI: (10.1016/S0272-6386(03)00905-3)