Chronic kidney disease-mineral and bone disorder (
CKD-MBD) encompasses laboratory and bone abnormalities and
vascular calcification and has deleterious effects on clinical outcomes. KDOQI (
Kidney Disease Outcomes Quality Initiative), an initiative of the National Kidney Foundation, addressed this issue with the publication of a clinical practice guideline for bone metabolism and disease in CKD in 2003, and 2 years later, a new definition and classification scheme for
CKD-MBD was developed following a KDIGO (
Kidney Disease: Improving Global Outcomes) Controversies Conference. The initial KDIGO guideline on
CKD-MBD was then published in 2009. New evidence was subsequently reviewed at the 2013 KDIGO Controversies Conference, and in 2017, KDIGO issued a clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of
CKD-MBD. This commentary presents the views of the KDOQI
CKD-MBD work group convened by the National Kidney Foundation. The KDOQI work group agrees with most of the KDIGO guideline update recommendations, particularly the suggestions regarding bone mineral density testing, joint assessments of longitudinal trends in
mineral metabolism markers, and dietary
phosphate counseling focused on
phosphate additives. However, the KDOQI work group has some concerns about the suggestions related to
hypocalcemia and
hypercalcemia,
phosphate-binder choice, and treatment of abnormal
parathyroid hormone concentrations. The overall goal of this commentary is to provide a broad discussion for the US nephrology community regarding
CKD-MBD and its diagnosis, prevention, and treatment.