Last updated: March 09, 2026
Medically reviewed by: NKF Patient Education Team
Learn how chronic kidney disease affects your bones and heart and the steps you can take to stay strong and protect your health.
About Mineral and Bone Disorder (CKD-MBD)
Your kidneys do many important jobs, such as:
- keeping the right balance of minerals in your blood, like calcium and phosphorus
- helping control levels of parathyroid hormone (PTH), a natural chemical messenger or signal
- helping your body use vitamin D
All these jobs combined help keep your bones strong and healthy. When you have chronic kidney disease (CKD), these minerals and hormones can get out of balance. The risk is higher in later stages of CKD, and highest in people with kidney failure who are on dialysis.
Over time, these changes can weaken your bones and damage your heart and blood vessels. This condition is called “mineral and bone disorder in chronic kidney disease” or CKD-MBD.
Signs and Symptoms
CKD-MBD usually happens slowly. Bone damage can happen over many years before you feel anything. Most people find out they have CKD-MBD from blood tests, not symptoms.
If you do have symptoms, you may notice:
- Bone or joint pain
- Weak bones that break easily
- Muscle cramps or weakness
- Pruritis (itchy skin)
- Feeling very tired
- Heart problems
- Nerve pain (burning, tingling, or numbness)
- Bone fractures (broken bones)
In children, symptoms may show up sooner. This is because their bones are still growing. Symptoms more common in children include not growing as expected (also known as growth faltering) or weak bones that break easily.
Causes
For people living with CKD, especially those with kidney failure who are on dialysis, CKD-MBD happens because the kidneys cannot:
- Remove extra phosphorus from your blood. This can cause high phosphorus (hyperphosphatemia).
- Turn vitamin D into its active form. This makes it harder for your body to absorb (take in) calcium from food to keep your bones strong.
When this happens, your parathyroid hormone (PTH) level can rise too high. This is called secondary hyperparathyroidism (SHPT). When PTH stays too high, your body pulls calcium out of your bones. Over time, this can make your bones weak and easier to break.
Keeping calcium, phosphorus, and PTH in balance can help protect the health of your bones and heart.
Complications
If CKD-MBD is not managed, it can lead to serious problems, such as:
- Broken bones (fractures)
- Slow bone growth in children, which can lead to shorter height that may continue into adulthood
- Bone deformities (abnormal shape or size)
- Heart and blood vessel problems - high calcium or phosphorus levels can cause your blood vessels to harden (also known as calcification). This increases your risk of heart attack, heart failure, and stroke.
These problems can make daily life harder. You may have more pain, less strength, or trouble moving around. Some people may need to go to the hospital more often. Serious bone breaks and heart problems can even increase the risk of death.
Diagnosis
Healthcare professionals diagnose CKD-MBD by reviewing your health history, doing a physical exam, and ordering blood tests. Additional testing may be needed depending on your situation.
Tests
Your healthcare team may order blood tests for CKD-MBD to check your levels of:
- Phosphorus
- Calcium
- Parathyroid hormone (PTH) (sometimes called “intact PTH” or “iPTH”)
- Vitamin D
- Alkaline phosphatase (a potential marker of bone breakdown)
You may also need imaging tests, such as an X-ray, bone density scan (DEXA), echocardiogram (ECHO), or CT scan. These tests can help show how strong your bones are and whether calcium is building up in your heart or blood vessels. In rare cases, a bone biopsy may be needed. This is when a small piece of bone is removed and looked at under a microscope.
When used together, these tests can help your care team find the cause of the problem and recommend the best treatment plan for you.
Treatment
Overview
Treatment for CKD-MBD focuses on a combination of nutrition, medicine, and physical activity. The main goals of treatment are to lower the levels of phosphorus and PTH in your blood while keeping healthy levels of calcium and vitamin D. This helps protect your bones and blood vessels. Work with your healthcare team to find the best treatment combination for you.
Medicines and Supplements
Medicines can help keep phosphorus, PTH, vitamin D, and calcium levels in a safe range. Some options are only recommended for people who are on dialysis. Your care team may prescribe one or more of these treatments:
- Phosphate binder: taken with each meal and snack to “bind” to phosphorus in your food so less gets into your blood. Examples include ferric citrate (Auryxia), lanthanum carbonate (Fosrenol), sevelamer (Renagel, Renvela), or sucroferric oxyhydroxide (Velphoro).
- Phosphate blocker: taken twice a day to lower how much phosphorus can move into your blood from your intestines. The only option currently available is tenapanor (Xphozah).
- Vitamin D supplement or active vitamin D: helps lower PTH levels and boost your vitamin D levels to support bone health. Example active vitamin D products include calcitriol (Rocaltrol), doxercalciferol (Hecterol), and paricalcitol (Zemplar).
- Calcimimetic (kal-sih-my-MET-ik): helps lower PTH levels without raising calcium levels. Often used to treat secondary hyperparathyroidism (SHPT) in people on dialysis. Examples include cinacalcet (Sensipar) and etelcalcitide (Parsabiv).
- Calcium supplement: can work as a phosphate binder and help boost your calcium levels for bone health. But it can also increase the risk of hardening your blood vessels. So, only take one if your care team recommends it for you. Do not start it on your own. Examples include calcium acetate (Phoslo, Phoslyra, Eliphos, Calphron), calcium carbonate (Tums), or calcium citrate (Citracal).
- Osteoporosis medicines: some people have CKD-MBD and osteoporosis, which is another condition that causes weak bones. These medicines are not right for everyone with CKD, but they may help some people maintain bone health, especially in earlier stages of CKD.
Nutrition
Limiting the amount of phosphorus in your diet is an important step for anybody living with CKD-MBD. This can be difficult since phosphorus is found in many foods.
- Natural (organic) phosphorus is found in many protein-rich foods such as meat, poultry, fish, nuts, beans and dairy products. The goal is not to remove these foods from your diet. Many of these foods contain protein and other nutrients that are important for your health. Rather, it is important to find a balance that works for you. Choices should also consider your risk level for high phosphorus, other health conditions, culture, budget, and preferences. Food source is important - phosphorus in animal foods is absorbed more easily than phosphorus found in plant foods. Also, fiber-rich foods can help reduce absorption of phosphorus.
- Inorganic phosphorus is found in fast foods, ready to eat foods, canned and bottled drinks, enhanced meats, and most processed foods. This type of phosphorus is completely absorbed into your blood. Avoiding these sources of phosphorus can really help you manage your phosphorus levels. To find these sources of phosphorus, check the ingredients list on the nutrition facts label for words with PHOS in them (for example: phosphoric acid, tricalcium phosphate, etc.).
Changing how you eat is hard. Working with a kidney dietitian can help you find the best approach that works for your personal situation.
Physical Activity
Being active helps keep your bones strong. The best exercises for bone health are called strength training/weight-bearing and flexibility exercises. These include:
- Walking
- Using resistance bands
- Lifting light weights
- Stretching, yoga, or Tai Chi
Always talk with your care team before starting a new exercise program to make sure it is safe for you.
Dialysis
While dialysis does not treat CKD-MBD directly, it can help by removing extra phosphorus from your blood. While all types of dialysis remove phosphorus, people who receive hemodialysis treatments at home (either short daily or nocturnal [overnight]) have a lower risk of developing high phosphorus levels because they’re getting dialysis treatments more often. If you are on dialysis, ask your healthcare professional if your dialysis settings can be changed to help lower your phosphorus.
Surgery
In some cases, your care team may suggest surgery to remove one or more of your parathyroid glands. Most people are born with four parathyroid glands. Each one is about the size of a pea, located in your neck very close to your thyroid. Your parathyroid glands are your body’s source for PTH. So, removing these glands can help control your PTH levels. This procedure is called parathyroidectomy and is usually only considered when other treatments do not work.
Preparing for your appointment
Questions to ask
- What are my recent calcium, phosphorus, and PTH levels?
- What is my goal range for calcium, phosphorus, and PTH levels?
- Are my levels in a safe range?
- How often should I have my levels checked?
- Am I a candidate for a bone density (DEXA) scan?
- Do I need any additional tests to screen for CKD-MBD or monitor my bone and heart health?
- Can you refer me to a kidney dietitian?
- What types of exercises would be most helpful for my CKD-MBD?
