[Brussels, Belgium] KDIGO has published the final report from its Controversies Conference on Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD): Progress and Knowledge Gaps Towards Personalizing Care, co-chaired by Markus Ketteler, MD (Germany) and Rosa Moysés, MD (Brazil). The conference brought together leading experts from around the world to evaluate new research, discuss clinical challenges, and explore innovative strategies to improve patient outcomes, with a focus on bone fragility, vascular calcification, and mineral metabolism.
The report, published in the March issue of Kidney International, acknowledges the global health challenge of CKD-MBD, and its effect on both skeletal and cardiovascular systems in people with CKD. The report highlights the growing need for personalized care in CKD-MBD management and introduces a refined framework that aligns with the latest scientific evidence.
“Our understanding of CKD-MBD has grown far beyond simply managing biochemical markers,” said Dr. Ketteler. “This report highlights the intricate relationship between bone health and cardiovascular disease in CKD patients and calls for a personalized care model that addresses the broader clinical picture. Managing CKD-MBD isn’t just about correcting lab values—it’s about preventing fractures, mitigating cardiovascular risks, and improving quality of life. It’s time to move away from rigid, one-size-fits-all frameworks and towards strategies that reflect the unique needs of each patient.”
The report encourages managing CKD-MBD through two primary syndromes: CKD-associated osteoporosis, which focuses on fracture prevention and bone health, and CKD-associated cardiovascular disease, which addresses vascular calcification and cardiac complications. Key recommendations include rethinking diagnostic strategies with advanced imaging and novel biomarkers, customizing phosphate and calcium management to balance bone and cardiovascular health, and refining treatment targets for parathyroid hormone (PTH), vitamin D, and other mineral metabolism markers to better reflect individual patient needs. The report also calls for more inclusive clinical trials to close evidence gaps, especially for post-transplant populations and pediatric patients.
“One of the most powerful messages from this meeting is that CKD-MBD management must center on the patient, not just the disease,” said Dr. Moysés. “This report recognizes that factors like inflammation, uremic toxins, immune dysregulation, and gut health all influence CKD-MBD progression. We need strategies that go beyond surface-level treatment and address the root causes, while also considering the patient’s overall health, lifestyle, and preferences. By embracing a holistic, patient-centered approach, we can reduce fracture risk, slow cardiovascular disease progression, and ultimately improve survival and quality of life.”
The report outlines critical knowledge gaps and a forward-looking research agenda. It calls for more randomized controlled trials, deeper exploration of patient-centered outcomes, and the development of emerging diagnostic tools to guide future care strategies.
You can read the report in Kidney International and the KDIGO CKD-MBD Controversies Conference website.
