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Current Osteoporosis Reports
Published in: Current Osteoporosis Reports 3/2017

Open Access 01-06-2017 | Kidney and Bone (S Moe and I Salusky, Section Editors)

Calcium Balance in Chronic Kidney Disease

Authors: Kathleen M. Hill Gallant, David M. Spiegel

Published in: Current Osteoporosis Reports | Issue 3/2017

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Abstract

Purpose of Review

The kidneys play a critical role in the balance between the internal milieu and external environment. Kidney failure is known to disrupt a number of homeostatic mechanisms that control serum calcium and normal bone metabolism. However, our understanding of calcium balance throughout the stages of chronic kidney disease is limited and the concept of balance itself, especially with a cation as complex as calcium, is often misunderstood. Both negative and positive calcium balance have important implications in patients with chronic kidney disease, where negative balance may increase risk of osteoporosis and fracture and positive balance may increase risk of vascular calcification and cardiovascular events. Here, we examine the state of current knowledge about calcium balance in adults throughout the stages of chronic kidney disease and discuss recommendations for clinical strategies to maintain balance as well as future research needs in this area.

Recent Findings

Recent calcium balance studies in adult patients with chronic kidney disease show that neutral calcium balance is achieved with calcium intake near the recommended daily allowance. Increases in calcium through diet or supplements cause high positive calcium balance, which may put patients at risk for vascular calcification. However, heterogeneity in calcium balance exists among these patients.

Summary

Given the available calcium balance data in this population, it appears clinically prudent to aim for recommended calcium intakes around 1000 mg/day to achieve neutral calcium balance and avoid adverse effects of either negative or positive calcium balance. Assessment of patients’ dietary calcium intake could further equip clinicians to make individualized recommendations for meeting recommended intakes.
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Metadata
Title
Calcium Balance in Chronic Kidney Disease
Authors
Kathleen M. Hill Gallant
David M. Spiegel
Publication date
01-06-2017
Publisher
Springer US
Published in
Current Osteoporosis Reports / Issue 3/2017
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-017-0368-x

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