CKD and Mineral and Bone Disease

When the kidneys stop working as well as they should, many things begin to go wrong in the body. One of the most common health issues that can occur with chronic kidney disease (CKD) and kidney failure is mineral and bone disease.^1,2

Mineral and bone disease in people with CKD or kidney failure happens when blood levels of the minerals calcium and phosphorus become out of balance. Such mineral imbalances lead to weak bones and problems with the heart and blood vessels.^1,2

Your doctor may call this CKD mineral and bone disorder, or CKD-MBD. The bone disease part of this condition is known as renal osteodystrophy.²

How the kidneys contribute to bone health

When the kidneys are working well, they do the following jobs:¹

• Remove waste and extra fluid
• Help the body make red blood cells
• Balance mineral levels and hormones in the blood
• Keep bones healthy

When you have later stages of kidney disease, and especially kidney failure, the kidneys cannot keep up with this important work. The kidneys no longer filter extra phosphorus from the blood and send it out in urine. This causes phosphorus to build up in the body. At the same time, unhealthy kidneys cannot change vitamin D into a form the body can use.^2,3

As phosphorus levels in the blood go up and vitamin D levels go down, the body reacts by making too much parathyroid hormone (PTH). High PTH levels cause the bones to lose calcium, making the bones weaker and more likely to break. High PTH may also make heart and blood vessel disease worse.³

Mineral and bone disease is common in people with kidney disease and kidney failure. It is most common in people who have kidney failure, are on dialysis, and are:²

• Women
• Age 65 or older
• Black

Symptoms of mineral and bone disease

Signs that someone with kidney disease or kidney failure has developed mineral and bone disease include:^2,3

• Itchy skin
• Bone pain and fractures
• Blocked blood vessels and heart problems
• Anemia
• Nerve problems
• Catching infections easily

Diagnosing mineral and bone disease

Doctors diagnose kidney-related mineral and bone disease by conducting a physical exam and several tests. The tests may include:²

• Blood tests to check vitamin and mineral levels
• Imaging tests (CT scan, X-ray) to look for bone changes and deposits in blood vessels and the heart
• Rarely, a taking a small sample of bone (bone biopsy) to check bone health

Treatments for kidney-related mineral and bone disease

CKD mineral and bone disease is complex to treat. It requires a combination of diet changes and medicines. The most common treatments for CKD are:^1,2

• Eating a low-phosphorus diet to keep blood phosphorus levels in a healthier range
• Doing weight-bearing exercise to strengthen bones
• Taking drugs such as:
• Phosphate binders to reduce blood phosphorus levels
• Vitamin D and calcium supplements to improve bone health
• Calcitriol and calcimimetics to lower PTH levels
• Starting dialysis
• Having surgery to remove the parathyroid gland

You cannot prevent mineral and bone disorder. But you can delay it or slow down how fast it gets worse by following the same recommendations that slow kidney disease.¹