Novel therapeutic agents and strategies for the management of chronic kidney disease mineral and bone disorder

Abnormalities in the serum concentrations of calcium, phosphate, parathyroid hormone and vitamin D develop with declining renal function, leading in turn to renal osteodystrophy. Observational data now suggest that these disturbances in bone and mineral metabolism play an important role in the development of vascular calcification and subsequent cardiovascular disease, contributing to the high burden of cardiovascular disease within this population. A new nomenclature-"chronic kidney disease mineral and bone disorder"-has been introduced to describe this broader clinical syndrome and reflect the new emphasis that has been placed upon its management. This article describes the current therapeutic options for this condition, focusing particularly on the novel medications and strategies that have recently been introduced, and highlighting promising therapeutic possibilities for the future.