Pediatric Nephrologyhttp5/doi.org/10.1007/s00467-022-05825-6GUIDELINESpDiagnosis and management of mineral and bone disorders in infantswith CKD:clinical practice points from the ESPN CKD-MBD and Dialysisworking groups and the Pediatric Renal Nutrition TaskforceJustine Bacchetta23.Claus Peter Schmitt4.Sevcan A.Bakkaloglu5.Shelley Cleghorns.Maren Leifheit-Nestler7.Agnieszka Prytula8.Bruno Ranchin1.Anne Schon7.Stella Stabouli9.Johan Van de Walle8.Enrico Vidal10.11.Dieter Haffner?.Rukshana Shroff5Received:5 August 2022/Revised:19 October 2022/Accepted:9 November 2022The Author(s)2023AbstractBackground Infants with chronic kidney disease (CKD)form a vulnerable population who are highly prone to mineral andbone disorders (MBD)including biochemical abnormalities,growth retardation,bone deformities,and fractures.We presenta position paper on the diagnosis and management of CKD-MBD in infants based on available evidence and the opinionof experts from the European Society for Paediatric Nephrology(ESPN)CKD-MBD and Dialysis working groups and thePediatric Renal Nutrition Taskforce.Methods PICO(Patient,Intervention,Comparator,Outcomes)questions were generated,and relevant literature searchesperformed covering a population of infants below 2 years of age with CKD stages 2-5 or on dialysis.Clinical practicepoints(CPPs)were developed and leveled using the American Academy of Pediatrics grading matrix.A Delphi consensusapproach was followed.Results We present 34 CPPs for diagnosis and management of CKD-MBD in infants,including dietary control of calciumand phosphate,and medications to prevent and treat CKD-MBD (native and active vitamin D,calcium supplementation,phosphate binders).Conclusion As there are few high-quality studies in this field,the strength of most statements is weak to moderate,and mayneed to be adapted to individual patient needs by the treating physician.Research recommendations to study key outcomemeasures in this unique population are suggested.Keywords Infants.Dialysis.Mineral and bone disorders.Calcium.Phosphate.PTH.Bone.Clinical practice points☒Rukshana Shroff6 Renal Unit,UCL Great Ormond Street Hospital and Instituterukshana.shroff@gosh.nhs.ukof Child Health.London.UKJustine BacchettaDepartment of Pediatric Kidney,Liver and Metabolicjustine.bacchetta@chu-lyon.frDiseases.Hannover Medical School.Pediatric ResearchCenter.Hannover,GermanyReference Center for Rare Renal Diseases,Reference Centerfor Rare Diseases of Calcium and Phosphate Metabolism.Department of Pediatric Nephrology and Rheumatology,Pediatric Nephrology Rheumatology and Dermatology Unit.Ghent University Hospital,Ghent,BelgiumHopital Femme Mere Enfant.Boulevard Pinel.69677 Bron.9Ist Department of Pediatrics,School of Medicine,FacultyFranceof Health Sciences.Aristotle University Thessaloniki.INSERM 1033 Research Unit,Lyon,FranceHippokratio Hospital,Thessaloniki,Greece10Lyon Est Medical School,Universite Claude Bernard,LyonPediatric Nephrology Unit,University-Hospital of Padova,P
