Chronic Kidney Disease–Mineral and Bone Disorder

Chronic kidney disease (CKD)–mineral bone disorder (MBD) is defined as a systemic disorder of mineral and bone metabolism due to CKD and is manifested by either one or a combination of the following: (1) abnormalities of calcium, phosphorus, parathyroid hormone (PTH), or vitamin D metabolism; (2) abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and (3) vascular or other soft-tissue calcification. All of these abnormalities are associated with increased mortality in patients with CKD. Management of this complex disorder includes lowering dietary phosphate intake, administration of phosphate binders, use of calcimimetics, vitamin D, and an appropriate dialysis prescription. In the past decade, there have been more data suggesting the potentially harmful effect of calcium-containing phosphate binders and use of high dialysate calcium concentrations on vascular calcification, which could contribute to the high cardiovascular mortality in patients with CKD.