Bones, Kidneys and Hearts: 3 Moving Targets

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September 12, 2023 18:00

End Date

September 12, 2023 19:00

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The fact that advanced kidney disease is more dangerous than most cancers is not widely appreciated beyond the sphere of those who study and care for these patients. The risk of death faced by a young adult dialysis patient is 50-100 fold greater than that of a person of similar age without kidney disease.

The impact of kidney disease on survival exhibits a dose-response effect, with increasingly powerful negative effects seen as the level of kidney function falls. Many of the deaths are cardiovascular but substantial additional morbidity and mortality are related to metabolic bone disease whereby the CKD-MBD syndrome (of which osteoporosis is a component) increases fracture risk and makes those fractures much more dangerous than they are in the ’ non-renal population.

These cardiovascular and skeletal effects are seen regardless of the cause of the kidney disease, though may be amplified by some, for example,
diabetes. Successful transplantation dramatically reduces these hazards, though does not eliminate them. Diverse biomechanical and metabolic
disturbances, increasingly florid as the level of kidney function falls, are the main drivers but drilling down reveals a complex scenario with crosstalk between kidney and heart, kidney and bone, and heart and bone.

Mitigation centres around prevention of the primary kidney disease (often not possible), slowing its progression, or substitution by transplantation. Further mitigation includes measures to minimise the severity of CKD-MBD syndrome and the damaging impact of this syndrome on the circulation and skeleton.