Chronic Kidney Disease and Mineral and Bone Disorder Management
This chapter discusses chronic kidney disease and mineral bone disorder (CKD-MBD) and the role it plays in the increased incidence of cardiovascular morbidity and mortality in CKD. Just how great is the risk? After adjusting for age, race, and gender, cardiovascular disease (CVD) mortality rates in patients with CKD Stage 5 are 10-20 times those of the general population (Foley et al., 1998). Most patients with advanced CKD present with vitamin D de”ciency, secondary hyperparathyroidism (SHPT), hypertension, insulin resistance, vascular calci”cations, and dyslipidemia. These comorbidities may start early in Stage 3 CKD and, though they seem dissimilar, have more in common than is apparent at ”rst review (Andress, 2005; Becker et al., 2005; Elder, 2002; Kramer et al., 2005).