Desde las guías americanas KDOQI™ 2003 hasta las guías españolas 2011: desde el diagnóstico y evaluación hasta el tratamiento de las alteraciones del metabolismo mineral y óseo en la enfermedad renal crónica

The present article compares the development of the various guidelines over time, with special emphasis on the Spanish adaptations of the latest universal but sometimes impractical KDIGO 2009 guidelines. Suggestions based on expert opinion are frequent, but there are still many similarities between the current Spanish therapeutic goals and the former KDOQI™. The main differences over time are the increasing relevance of phosphate control, PTH target levels, and the evaluation of vascular/valvular calcifications, since this information can reasonably be used to guide the management of CKD-MBD. Many of us believe that the lack of 1A evidence justifies critical attitudes but should not be used as a reason to vindicate therapeutic nihilism o passive approaches while definitive results from prospective studies are awaited.