[New Developments in CKD-MBD. The management of posttransplant CKD-MBD : When, Who, and How?]

Chronic kidney disease - mineral and bone disorder (CKD-MBD) in kidney transplant recipients has a complex pathophysiology, which is a combination of carryover of mineral and bone disorder during the dialysis period and dynamic change in bone and mineral metabolism after transplantation. The most important thing is to know that this pathophysiology is a continuum from the early stage of CKD through the dialysis period to the post-transplant period. However, the current treatment approaches among Japanese nephrologists are based on three different categories : nephrologists elaborately treating predialysis patients against end-stage renal disease ; dialysis doctors aggressively coping with their patients' deadly complications ; and transplant doctors concentrating on post-transplant follow-ups for better graft survival. In this article, I would like to explain the pathophysiology of post-transplant CKD-MBD and then to introduce a new role -- that not only transplant doctors, but also dialysis doctors, should play a crucial role in CKD-MBD in the post-transplant period.