[Fragility Fractures in Hemodialysis Patients. Uremic toxins-related abnormal bone metabolism.]

Uremic toxins are increased with deterioration of kidney function and the levels are associated with progression of uremic syndrome. Uremic toxins are associated with various chronic kidney disease(CKD)-related systemic disease, and bone is one of major targets. Recent clinical and basic studies show that protein-bound uremic toxins, such as indoxyl sulfate(IS)and p-crecyl sulfate(PCS), parathyroid hormone, and renin-angiotensin-aldosterone system(RAAS)are associated with bone fragilities. IS and PCS induce skeletal resistance to PTH in osteoblasts and osteoclasts as well as impairment of bone quality. Inhibition of the reaction of uremic toxins with bone is important therapeutic strategies for CKD-related bone fragilities in addition to treatment for CKD-mineral and bone disorder, and osteoporosis.