Chronic kidney disease-mineral-bone disorder: a new paradigm

Area of Science:

• Nephrology
• Endocrinology
• Pathology

Background:

• Mineral and bone metabolism disturbances are common in chronic kidney disease (CKD).
• These disturbances contribute to significant morbidity, reduced quality of life, and extraskeletal calcification.
• Traditional classification relied on bone biopsy to define renal osteodystrophy.

Purpose of the Study:

• To evaluate and redefine the terminology for mineral and bone disorders in CKD.
• To establish a broader definition encompassing the systemic nature of these disorders.
• To differentiate between bone morphology changes and the overall clinical syndrome.

Main Methods:

• A KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference was convened.
• Expert consensus was used to evaluate existing definitions and propose new terminology.
• The proposed definition of CKD-MBD was based on laboratory, bone, and calcification abnormalities.

Main Results:

• Recommended using "renal osteodystrophy" solely for bone morphology alterations in CKD.
• Introduced "CKD-mineral and bone disorder (CKD-MBD)" for the systemic clinical syndrome.
• CKD-MBD encompasses abnormalities in calcium, phosphorus, PTH, vitamin D, bone characteristics, and calcification.

Conclusions:

• The new terminology provides a clearer framework for understanding and managing mineral and bone disorders in CKD.
• CKD-MBD represents a broader, systemic clinical syndrome beyond just bone morphology.
• This revised classification aims to improve patient outcomes by addressing the multifaceted nature of these disturbances.