Understanding Chronic Kidney Disease- Mineral Bone Disorder (CKD-MBD)

Chronic kidney disease (CKD) is commonly associated with disorders of mineral and bone metabolism, manifested by either one or a combination of the following three components namely : Abnormalities of calcium, phosphorus, parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), and vitamin D metabolism; Abnormalities in bone turnover, mineralization, volume linear growth, or strength; and Extraskeletal calcification. This topic reviews the pathogenesis of CKD-MBD. The pathophysiology of the disorder is complex and involves a number of feedback loops between the kidney, bone, intestine, and the vasculature. The main goal of this system is maintenance of calcium and phosphorus balance, often at the expense of abnormalities in other components of the system. While most elements of CKD–MBD are usually present when the glomerular filtration rate (GFR) falls below 40 mL/min, some components may be observed earlier in the course of CKD and precede the onset of clinically detectable abnormalities in serum phosphorus, calcium, PTH, and vitamin D. These include decreased bone formation rates, vascular calcification, loss of klotho, and increased FGF23 secretion