Abnormalities in mineral metabolism worsen with progression of chronic kidney disease (CKD) and are associated with an increased risk of end-stage renal disease (ESRD) among African American individuals with hypertensive kidney disease, according to new research. Using data from the AASK study, Scialla et al. found that serum levels of FGF23, PTH and phosphate increased during 4 years of follow-up; the greatest increases were seen in participants with the fastest rates of decline in glomerular filtration rate (GFR). Higher baseline levels of these mineral metabolites were each associated with increased risk of ESRD or death independent of GFR.