Review article: Addressing risk factors in chronic kidney disease mineral and bone disorder: can we influence patient-level outcomes?

Chronic kidney disease mineral and bone disorder (CKD-MBD), characterized by disturbances of calcium/phosphate/parathyroid hormone, bone abnormalities and vascular and soft tissue calcification, is highly prevalent in CKD and is a strong, independent predictor of bone fracture, cardiovascular disease and death. Clinical practice guidelines, such as the Kidney Disease Outcomes Quality Initiative (KDOQI) and Caring for Australasians with Renal Insufficiency (CARI), support the use of phosphate binders, vitamin D compounds and calcimimetics for treatment of CKD-MBD and recommend stringent targets for serum calcium, phosphate and parathyroid hormone. However, these recommendations are based primarily on the results of observational cohort studies and randomized controlled trials employing surrogate outcome measures. The aim of this paper is to review the available evidence addressing whether therapeutic strategies targeting CKD-MBD and its surrogate outcome measures appreciably influence patient-level outcomes ('hard' clinical end-points).