Chronic kidney disease–mineral and bone disorder: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

• Published in: Kidney international Vol. 107; no. 3; pp. 405 - 423
• Main Authors: Ketteler, Markus, Evenepoel, Pieter, Holden, Rachel M., Isakova, Tamara, Jørgensen, Hanne Skou, Komaba, Hirotaka, Nickolas, Thomas L., Sinha, Smeeta, Vervloet, Marc G., Cheung, Michael, King, Jennifer M., Grams, Morgan E., Jadoul, Michel, Moysés, Rosa M.A., Alfieri, Carlo, Ashuntantang, Gloria, Bavanandan, Sunita, Bellasi, Antonio, Bover, Jordi, Bueno de Oliveira, Rodrigo, Bushinsky, David A., Bressendorff, Iain, Fernandes Canziani, Maria Eugênia, Carvalho, Aluizio Barbosa, Cavalier, Etienne, Cejka, Daniel, Chen, Wei, David, Val, de Borst, Martin H., Denburg, Michelle, Elder, Grahame J., Elias, Rosilene M., Floege, Jürgen, Fukagawa, Masafumi, Fusaro, Maria, Gallego, Daniel, Ginsberg, Charles, Goh, Bak-Leong, Gomez Acevedo, Rafael Alberto, Gutierrez, Orlando M., Hamano, Takayuki, Hansen, Ditte, Haarhaus, Mathias, Huish, Sharon A., Ix, Joachim H., Jardine, Meg, Khairallah, Pascale, Kwon, Young joo, Lafage-Proust, Marie-Hélène, Loughton, Holly, Mac-Way, Fabrice, Mazzaferro, Sandro, Negri, Armando Luis, Nigwekar, Sagar U., Noronha, Irene L., Ott, Susan M., Perwad, Farzana, Salusky, Isidro B., Scialla, Julia J., Susantitaphong, Paweena, Tchokhonelidze, Irma, Terano, Chikako, Tonelli, Marcello, Tsukamoto, Yusuke, Walsh, Michael, Yee-Moon Wang, Angela, Wesseling-Perry, Katherine, Wolf, Myles, Wong, Jiunn
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2025
• Subjects: calcium; Chronic Kidney Disease-Mineral and Bone Disorder - diagnosis; Chronic Kidney Disease-Mineral and Bone Disorder - etiology; Chronic Kidney Disease-Mineral and Bone Disorder - therapy; CKD-MBD; Humans; Minerals - metabolism; Nephrology - standards; Osteoporosis - etiology; parathyroid hormone; Parathyroid Hormone - metabolism; phosphate; Practice Guidelines as Topic; Renal Insufficiency, Chronic - complications; renal osteodystrophy; Vascular Calcification - etiology; vitamin D; Vitamin D - blood; Vitamin D - metabolism; phosphate; parathyroid hormone; calcium; renal osteodystrophy; vitamin D; CKD-MBD
• ISSN: 0085-2538; 1523-1755; 1523-1755
• DOI: 10.1016/j.kint.2024.11.013

In 2017, Kidney Disease: Improving Global Outcomes (KDIGO) published a Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Since then, new lines of evidence have been published related to evaluating disordered mineral metabolism and bone quality and turnover, identifying and inhibiting vascular calcification, targeting vitamin D levels, and regulating parathyroid hormone. For an in-depth consideration of the new insights, in October 2023, KDIGO held a Controversies Conference on CKD-MBD: Progress and Knowledge Gaps Toward Personalizing Care. Participants concluded that the recommendations in the 2017 CKD-MBD guideline remained largely consistent with the available evidence. However, the framework of the 2017 Guideline, with 3 major sections—biochemical abnormalities in mineral metabolism; bone disease; and vascular calcification—may no longer best reflect currently available evidence related to diagnosis and treatment. Instead, future guideline efforts could consider mineral homeostasis and deranged endocrine systems in adults within a context of 2 clinical syndromes: CKD-associated osteoporosis, encompassing increased fracture risk in patients with CKD; and CKD-associated cardiovascular disease, including vascular calcification and structural abnormalities, such as valvular calcification and left ventricular hypertrophy. Participants emphasized that the complexity of bone and cardiovascular manifestations of CKD-MBD necessitates personalized approaches to management.