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

Pieter EvenepoelHanne Skou JørgensenJordi BoverAndrew DavenportJustine BacchettaMathias HaarhausDitte HansenCarolina Gracia-IguacelMarkus KettelerLouise McAlisterEmily WhiteSandro MazzaferroMarc G VervloetRukshana Shroffnull null
Published in: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (2023)
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 control 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. Main clinical practice points include a suggested total calcium intake from diet and medications of 800-1000 mg/d and not exceeding 1500 mg/d to maintain a neutral calcium balance in adults with CKD. In children with CKD, total calcium intake should be kept within the 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.
Keyphrases
  • chronic kidney disease
  • end stage renal disease
  • clinical practice
  • young adults
  • bone mineral density
  • physical activity
  • mental health
  • decision making
  • weight loss
  • living cells
  • health information
  • newly diagnosed