Editorial Comment Calcimimetics, vitamin D and ADVANCE in the management of CKD-MBD

Disorders in mineral homeostasis and bone are recog-nized today as having a fundamental role in the cardio-vascular complications of chronic kidney disease (CKD). This syndrome has been named ‘CKD-mineral bone dis-order ’ (CKD-MBD) [1]. The current understanding of the initial mechanisms involved in the pathogenesis of CKD-MBD is focused on very early increases in the skeletal hormone, FGF23, as a sign of disturbed skeletal function [2], loss of skeletal anabolism, hyperphosphataemia, de-creased calcitriol and secondary hyperparathyroidism (sHPT). In the later stage, vascular calcification develops. Four different sites of ‘vascular calcification ’ have been described in CKD patients: arterial intimal calcifications, arterial medial calcifications, calcification of the cardiac valves and calcific uraemic arteriolopathy [3]. The calci