Improving global outcomes in mineral and bone disorders.

Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease and an important cause of morbidity, decreased quality of life, and extraskeletal calcification that have been associated with increased cardiovascular mortality. Kidney Disease: Improving Global Outcomes (KDIGO)'s Global Mineral and Bone Initiative has sought to update the definition, evaluation, and classification of this mineral and bone disorder; improve standardization of assessment tools; enhance education about these complications; and stimulate research. In addition, this international organization sponsored a Controversies Conference in 2005 to define these complications better. The recommendations from that conference were that (1) the term "renal osteodystrophy" be used exclusively to define alterations in bone morphology that are associated with chronic kidney disease and (2) the term "chronic kidney disease-mineral and bone disorder" (CKD-MBD) can be used to describe the broader clinical syndrome that develops as a systemic disorder of mineral and bone metabolism as a result of chronic kidney disease. Chronic kidney disease-related mineral and bone disorders is manifested by an abnormality of any one or a combination of the following: Laboratory (abnormalities of calcium, phosphorus, parathyroid hormone, or vitamin D metabolism), bone (changes in bone turnover, mineralization, volume, linear growth, or strength), and calcification (vascular or other soft tissue calcification). The use of a common, internationally accepted terminology should ease the comparison of studies in this field and eventually improve patient care worldwide.