Development of a quantitative systems pharmacology model of chronic kidney disease - metabolic bone disorder
Chronic kidney disease mineral bone disorder (CKD-MBD) is a virtually universal complication of kidney diseases, starting early in the course of disease and resulting in devastating clinical consequences ranging from bone fragility to accelerated atherosclerosis and early cardiovascular death. Guidelines for therapeutic goals for CKD-MBD have been published, and achievement of these guidelines is associated with improved survival. However, the incomplete understanding of CKD-MBD and the individual variability in the manifestations of CKD-MBD has made it difficult to achieve these guidelines. We hypothesized that the progression of MBD through all stages of CKD, including End Stage Kidney Disease could be represented by a Quantitative Systems Pharmacology/Systems Biology (QSP) model. To address this hypothesis, we constructed a QSP model of CKD-MBD, building on an open-source model of calcium and phosphorus metabolism. Specifically, we estimated and validated the model using data from 5496 CKD patients enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Our model accurately predicted changes in markers of mineral metabolism related to progressing CKD. We demonstrated that the incorporation of FGF23 and the soft tissue compartment is essential for accurate modeling of the changes in calcium, phosphorus, iPTH and calcitriol in CKD-MBD.