title: Current concepts and management strategies in chronic kidney disease-mineral and bone disorder.
abstract: The term renal osteodystrophy describes the pathological changes in bone structure in chronic kidney disease (CKD); however, this term fails to describe adequately the adverse changes in mineral and hormonal metabolism in CKD that have grave consequences for patient survival. CKD-mineral and bone disorder (CKD-MBD) is a broader, newly defined term that should be used instead of renal osteodystrophy to define the mineral, bone, hormonal, and calcific cardiovascular abnormalities that are seen in CKD. The new paradigm in the management of renal bone disease is to "think beyond the bones" and strive to improve cardiovascular outcomes and survival. This means treating other aspects of the disease process that go beyond merely controlling parathyroid hormone levels. Primary physicians need to take a proactive approach to the management of CKD-MBD because the disorder begins early in the course of CKD, well before a patient is referred to a nephrologist. This review outlines the evidence behind the understanding of CKD-MBD, its implications for overall mortality, and the latest recommendations for management of CKD-MBD in patients with predialysis CKD.
authors.affiliation: Division of Nephrology, Department of Medicine, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, PA 19102, USA. veeraish.chauhan@drexelmed.edu
authors.forename: Veeraish
authors.initials: V
authors.lastname: Chauhan
authors.forename: Ellie
authors.initials: E
authors.lastname: Kelepouris
authors.forename: Nishtha
authors.initials: N
authors.lastname: Chauhan
authors.forename: Megha
authors.initials: M
authors.lastname: Vaid
mesh_terms: D001842:Bone and Bones / Q000378:metabolism* / Q000473:pathology; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D005919:Glomerular Filtration Rate; D006801:Humans; D008903:Minerals / Q000378:metabolism*; D010002:Osteitis Fibrosa Cystica / Q000209:etiology / Q000378:metabolism*; D010018:Osteomalacia / Q000209:etiology / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy
chemical_list: D008903:Minerals