The term '
chronic kidney disease-mineral and bone disorder' (
CKD-MBD), coined in 2006, was introduced in a position statement by the
Kidney Disease: Improving Global Outcomes (KDIGO) organization. According to the KDIGO guidelines,
CKD-MBD is a systemic disorder and patients with vascular or valvular calcifications should be included in the group with the greatest cardiovascular risk. Therefore, the presence or absence of calcification is a key factor in strategy decisions for such patients. In particular, it is recommended that the use of
calcium-based
phosphate binders should be restricted in patients with hypercalcaemia,
vascular calcification, low levels of
parathyroid hormone (PTH) or adynamic
bone disease. In this respect, it should be underscored that treatment with
phosphate-binding agents can normalise the levels of
phosphate and PTH, but the use of
calcium carbonate can favour the progression of
vascular calcifications. There is evidence of reduced progression of
vascular calcification in patients treated with
sevelamer compared with high doses of
calcium-based binders, but there is as yet no strong evidence regarding hard outcomes, such as mortality or hospitalization, to support the use of one treatment over another. Nevertheless, a number of experimental and observational findings seem to suggest that
sevelamer should be preferred over
calcium-based binders, in as much as these can increase cardiovascular mortality when used in high doses. A threshold dose below which
calcium-based binders can be used safely in CKD patients with
hyperphosphatemia has yet to be established.