Vnitr Lek 2026, 72(4):240-246 | DOI: 10.36290/vnl.2026.048

Mineral and bone disorder in chronic kidney disease (CKD-MBD): a practical perspective for the internist

Kateřina Oulehle¹, Jan Vachek^{1, 2}, Oskar Zakiyanov², Martin Jedlička³, Richard Pikner^{4, 5}, Vladimír Tesař²

¹ Interní oddělení, Klatovská nemocnice, a. s.

² Klinika nefrologie 1. LF UK a VFN v Praze

³ Klinika otorinolaryngologie 3. LF UK a FNKV, Praha

⁴ Oddělení klinických laboratoří a kostního metabolismu, Klatovská nemocnice, a. s.

⁵ Ústav klinické biochemie a hematologie LF UK a FN Plzeň

disorders of mineral and bone metabolism in chronic kidney disease (CKD-MBD) represent a complex systemic syndrome involving dysregulation of calcium, phosphorus, parathyroid hormone (PTH), vitamin D, and fibroblast growth factor 23 (FGF23) metabolism, disturbances of bone remodeling and mineralization, and extraskeletal-particularly vascular and valvular-calcifications. Understanding of this issue has undergone a fundamental transformation: from an isolated perception of secondary hyperparathyroidism, through the concept of renal osteodystrophy, to the current integrated view that also includes osteoporosis, cardiovascular risk, and the overall clinical context. Current recommendations are moving away from a rigid treatment approach focused on achieving individual laboratory target values and instead emphasize dynamic evaluation of trends, individualized therapy, and prevention of maladaptive changes in bone turnover. Diagnosis is based primarily on monitoring calcium, phosphorus, PTH, 25-OH vitamin D, and alkaline phosphatase, ideally its bone-specific fraction; FGF23 and selected bone turnover markers are considered promising emerging tools. Untreated or insufficiently controlled CKD-MBD is associated with an increased risk of fractures, progression of renal osteodystrophy, vascular and valvular calcifications, left ventricular hypertrophy, heart failure, calciphylaxis, and other complications affecting both prognosis and the patient's transplant perspective. The aim of this article is to provide internists with a concise, practice-oriented overview of the current concept of CKD-MBD, its diagnosis, therapeutic options, and its relationship to other clinically significant complications.

Keywords: CKD-MBD, chronic kidney disease, renal osteodystrophy, secondary hyperparathyroidism, vitamin D, phosphate binders, sevelamer, paricalcitol, cinacalcet, osteoporosis, vascular calcification, cardiovascular complications.

Accepted: June 11, 2026; Published: June 24, 2026  Show citation