1. ¹Indiana University School of Medicine and Roudebush VAMC, Indianapolis, Indiana, USA
2. ²Inserm Unit 507 and Division of Nephrology, Hôpital Necker, Université René Descartes, Paris, France
3. ³The Royal Free Hospital and University College London, London, UK
4. ⁴Division of Nephrology, UCLA Medical Center, Los Angeles, California, USA
5. ⁵Division of Nephrology, St Louis University, St Louis, Missouri, USA
6. ⁶Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
7. ⁷University of Washington Medical Center, Seattle, Washington, USA
8. ⁸Evanston Northwestern Healthcare, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
9. ⁹Ghent University Hospital, Ghent, Belgium
10. ¹⁰Baylor College of Medicine, Houston, Texas, USA

Correspondence: S Moe, Department of Medicine, Indiana University School of Medicine, 1001 W 10th Street, OPW 526, Indianapolis, Indiana 46202, USA. E-mail: smoe@iupui.edu

Received 14 February 2006; Accepted 21 February 2006; Published online 26 April 2006.

Abstract

Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are an important cause of morbidity, decreased quality of life, and extraskeletal calcification that have been associated with increased cardiovascular mortality. These disturbances have traditionally been termed renal osteodystrophy and classified based on bone biopsy. Kidney Disease: Improving Global Outcomes (KDIGO) sponsored a Controversies Conference on Renal Osteodystrophy to (1) develop a clear, clinically relevant, and internationally acceptable definition and classification system, (2) develop a consensus for bone biopsy evaluation and classification, and (3) evaluate laboratory and imaging markers for the clinical assessment of patients with CKD. It is recommended that (1) the term renal osteodystrophy be used exclusively to define alterations in bone morphology associated with CKD, which can be further assessed by histomorphometry, and the results reported based on a unified classification system that includes parameters of turnover, mineralization, and volume, and (2) the term CKD-Mineral and Bone Disorder (CKD-MBD) be used to describe a broader clinical syndrome that develops as a systemic disorder of mineral and bone metabolism due to CKD, which is manifested by abnormalities in bone and mineral metabolism and/or extra-skeletal calcification. The international adoption of these recommendations will greatly enhance communication, facilitate clinical decision-making, and promote the evolution of evidence-based clinical practice guidelines worldwide.