Chronic Kidney Disease – Mineral and Bone Disorder (CKD-MBD)

Declining kidney function results in mineral and hormonal imbalances that trigger a maladaptive feedback loop favoring the oversecretion of parathyroid hormone (PTH). As kidney disease progresses, chronic hyperphosphatemia, elevated parathyroid hormone and fibroblast grown factor-23, low 1,25-dihydroxyvitamin D, hypocalcemia, and metabolic acidosis can collectively result in disordered bone turnover and vascular calcifications. The term chronic kidney disease – mineral and bone disorder (CKD-MBD) – is used to describe these imbalances and the increased risk of fracture, cardiovascular events, and mortality they confer. Preventing or delaying the progressive metabolic, vascular, and bone complications associated with CKD-MBD is essential. We provide a summary of how to assess and manage the mineral and bone disorders associated with advanced CKD.