Comparison of mineral metabolites as risk factors for adverse clinical outcomes in CKD

Patients with chronic kidney disease are at increased risk for progressing to end-stage renal disease, developing cardiovascular disease, and dying prematurely. Recent evidence has suggested that disordered mineral metabolism, which includes hyperphosphatemia, secondary hyperparathyroidism, vitamin D deficiency, and fibroblast growth factor 23 excess, may contribute to the high rates of adverse outcomes in this population. However, marked within-subject variability for some of these biochemical parameters exists, potentially detracting from the utility of certain metabolites as prognostic tools. This review summarizes the available data on the epidemiology of phosphate, parathyroid hormone, vitamin D, and fibroblast growth factor 23, and their relationships with adverse clinical outcomes in chronic kidney disease, compares the performance of each as a biomarker of risk and introduces recent insights into the pathophysiology behind some of the observed relationships.