Home Dialysis: Chronic Kidney Disease and Mineral and Bone Metabolism

All patients with end-stage kidney disease are at risk for detriments in bone and vascular health, labeled as chronic kidney disease-mineral and bone metabolism disease (CKD-MBD). The major players involved are calcium, phosphate, parathyroid hormone, FGF-23, and vitamin D. This tightly dependent system of homeostasis is easily disrupted from its delicate balance as glomerular filtration rate (eGFR) falls and kidney disease progresses. Regulated bone turnover becomes imbalanced and calcium deposition begins in vascular spaces it does not belong. Patients become at risk for bone fragility complications and worsened cardiovascular outcomes result. CKD-MBD knowledge by a nephrology clinician is imperative for the interdependent system and how to best control and modify increasing patient risk factors. Treatment with lifestyle recommendations and current medications can improve patients’ lives and modify morbidity and mortality.