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

General Information


  • systemic disorder of mineral and bone metabolism due to chronic kidney disease1

Also called



  • chronic kidney disease - mineral and bone disorder1
    • systemic disorder of mineral and bone metabolism due to chronic kidney disease
    • characterized by any of the following
      • abnormalities of calcium, phosphorous, parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23) derangements, or vitamin D metabolism
      • abnormalities of bone turnover, mineralization, volume, linear growth, or strength
      • extra-osseous calcification including arterial, valvular, and myocardial calcifications
  • renal osteodystrophy - alteration in bone morphology in patients with chronic kidney disease1
    • mild - slight increase in bone turnover and normal mineralization
    • osteitis fibrosa - increased turnover and normal mineralization
    • mixed renal osteodystrophy - increased turnover and abnormal mineralization
    • osteomalacia - decreased bone turnover and abnormal mineralization
    • adynamic bone - decreased bone turnover and acellularity
  • types of hyperparathyroidism related to kidney disease
    • secondary hyperparathyroidism
      • up to 90% of untreated patients with chronic kidney disease reported to develop secondary hyperparathyroidism by the time dialysis started
      • reduced vitamin D levels and decreased production of 1,25-hydroxyvitamin D in the kidney combined with high phosphate levels cause PTH levels to increase and calcium levels to decrease
    • tertiary hyperparathyroidism
      • most commonly occurs after renal transplant and in dialysis patients with poorly controlled mineral bone metabolism
      • patients with secondary hyperparathyroidism before transplant continue to have high PTH levels after transplant
      • long term hypocalcemia thought to lead to hypertrophy of parathyroid tissue which then continues to overproduce PTH after calcium levels and kidney disease has resolved (though adenoma must be ruled out)
    • Reference - 19836494Surg Clin North Am 2009 Oct;89(5):1227full-text
    • see Primary hyperparathyroidism for additional information


General references used

  1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009 Aug;(113):S1-130, focused 2017 update can be found in Kidney Int Suppl 2017 Jul;7(1):1, executive summary can be found in Kidney Int 2017 Jul;92(1):26
  2. Lewis R. Mineral and bone disorders in chronic kidney disease: new insights into mechanism and management. Ann Clin Biochem. 2012 Sep;49(Pt 5):432-40
  3. Moorthi RN, Moe SM. CKD-mineral and bone disorder: core curriculum 2011. Am J Kidney Dis. 2011 Dec;58(6):1022-36full-text

Recommendation grading systems used

  • Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommendations
    • strength of recommendation
      • Level 1 ("we recommend") - most patients should receive recommended course of action
      • Level 2 ("we suggest") - different choices appropriate for different patients, based on patient's values and preferences
      • Not Graded - topic does not allow adequate application of evidence, not meant to be interpreted as being stronger recommendations than Level 1 or 2
    • quality of evidence
      • Grade A - high-quality evidence, true effect lies close to that of estimate of effect
      • Grade B - moderate-quality evidence, true effect likely to be close to estimate of effect, but there is possibility it is substantially different
      • Grade C - low-quality evidence, true effect may be substantially different from estimate of effect
      • Grade D - very low-quality evidence, estimate of effect very uncertain and often far from truth
  • National Kidney Foundation (NKF) strengths of recommendation
    • Grade A
      • strongly recommended that clinicians routinely follow guideline for eligible patients
      • strong evidence that practice improves health outcomes
    • Grade B
      • recommended that clinicians routinely follow guideline for eligible patients
      • moderately strong evidence that practice improves health outcomes
    • Clinical Practice Recommendations (Grade CPR)
      • consider following guideline for eligible patients
      • based on weak evidence or opinions of Work Group and reviewers that practice might improve health outcomes
    • Reference - NKF clinical practice guideline on chronic kidney disease in children and adolescents: evaluation, classification, and stratification (12777562Pediatrics 2003 Jun;111(6 Pt 1):1416)

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T908720, Chronic Kidney Disease - Mineral and Bone Disorder (CKD-MBD); [updated 2018 Nov 30, cited place cited date here]. Available from Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.


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