International Urology and Nephrology

, Volume 40, Issue 2, pp 427–440 | Cite as

Bone and mineral disorders in pre-dialysis CKD

  • Csaba P. KovesdyEmail author
  • Kamyar Kalantar-Zadeh


Disorders in calcium, phosphorus, and parathyroid hormone (PTH) are common in chronic kidney disease (CKD) and may be associated with poor outcomes including a higher rate of CKD progression and increased death risk. Although these abnormalities have been examined extensively in patients with CKD stage 5 who are receiving chronic maintenance dialysis, they have not been studied to the same extent at earlier stages of CKD, in spite of the much larger numbers of patients in the early CKD population. We summarize the available literature on outcomes associated with bone and mineral disorders in patients with CKD not yet receiving maintenance dialysis. We have reviewed novel data linking fibroblast growth factor 23 (FGF-23) to phosphorus and vitamin D homeostasis. More rapid CKD progression is linked to hyperphosphatemia and its associated hyperparathyroidism and vitamin D deficiency. Hence, hyperphosphatemia may play a central role in the diverse disorders characterizing CKD. We provide a brief overview of the available treatment recommendations for bone and mineral disorders, with an emphasis on areas needing further research.


Chronic kidney disease Parathyroid hormone Hyperphosphatemia Mortality FGF-23 1,25-Dihydroxy-cholecalciferol 



Chronic kidney disease


Parathyroid hormone


Fibroblast growth factor 23


Maintenance hemodialysis


Mineral and bone disorder


Secondary hyperparathyroidism


Glomerular filtration rate


Modification of diet in renal disease




African American study of hypertension and kidney Disease




End stage renal disease



Conflict of interest

Csaba P. Kovesdy and Kamyar Kalantar-Zadeh have received grants and/or honoraria from Amgen (manufacturer of Sensipar™), Abbott (manufacturer of Calcijex™ and Zemplar™), Genzyme (manufacturer of Hectorol™, Renagel™ and Renvela™), and/or Shire (manufacturer of Fosrenol™).


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Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Division of NephrologySalem VA Medical CenterSalemUSA
  2. 2.University of VirginiaCharlottesvilleUSA
  3. 3.Harold Simmons Center for Kidney Disease Research and EpidemiologyTorranceUSA
  4. 4.Division of Nephrology and HypertensionLos Angeles Biomedical Research Institute at Harbor-UCLA Medical CenterTorranceUSA
  5. 5.David Geffen School of Medicine at UCLATorranceUSA

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