HISTORY

BACKGROUND
The clinical “syndrome” of CKD-MBD has been recognized as an important contributor to morbidity and mortality throughout all stages of CKD. In the past, research centers have traditionally and individually focused on some isolated aspects of this newly recognized entity. Nevertheless, CKD-MBD is a complex interaction of multiple disturbances finally resulting in heterogeneous sequelae. Thus, a common platform for educational, intellectual and personal-fellow exchange needed facilitate research in a field where many efforts are still needed.
It was felt that large scale cooperation between centers with special interest in these matters needed improvement in order to achieve a global and translational approach to pathophysiology, prevention and treatment of CKD-MBD. Research targets have not always met clinical needs and some urgent research targets have not still been adequately addressed, specially referring to important hard end-points.
HISTORY
Part of this kind of cooperation, such as exchange of expertise including fellow scholar and exchange programs started in 2010 as an international cooperative structure for centers with both scientific as well as clinical interests in CKD-MBD.

As a first step, four scientific symposia (Amsterdam 2010, Prague EDTA 2011, Barcelona 2011, Paris EDTA 2012), two Fellow Days – where young fellows had the opportunity to meet and interact with experts in CKD-MBD) and an additional Fellow Training Day 2011 at UDETMA (Atherothrombotic Disease Detection and Treatment Unit), Lleida (Spain), have already been organized.

A Supplement to Kidney International (2011) has been published by the core group as a summary report of their joint scientific interests and activities.

BOARD

Marc Vervloet (Netherlands) – Chair
Sandro Mazzaferro (Italy) – Vice Chair

Carlo Alfieri (Italy)
Martin H. de Borst (Netherlands)
Jordi Bover (Spain)
Etienne Cavalier (Belgium)
Daniel Cejka (Austria)
Maria Fusaro (Italy)
Mehmet Kanbay (Turkey)
Markus Ketteler (Germany)
Mathias Loberg Haarhaus (Sweden)
Smeeta Sinha (United Kingdom)

JOIN THE WORKING GROUP

Being a ordinary member of the CKD-MBD Working Group means being part of a network which facilitates exchanges of in the field of interest of CKD-MBD and Bone Mineral disorders in CKD.

Becoming an ordinary member of the CKD-MBD Working Group is FREE OF CHARGE. Ordinary members must be ERA members and be persons with a proven interest in the research area covered by the WG. Exceptions are possible only for non-nephrologists.

By joining the CKD-MBD Working Group you will receive constant updates on the Working Group initiatives be included in the Directory of CKD-MBD Working Groups’ ordinary members and start networking with colleagues from all over the world.

Click here to join.
The ordinary membership application is subject to validation. Please allow some time for a quick administrative check before applying multiple times.

PUBLICATIONS

Differentiating the causes of adynamic bone in advanced chronic kidney disease informs osteoporosis treatment
Kidney International, June 2021

Bone evaluation in paediatric chronic kidney disease: Clinical practice points from the European Society for Paediatric Nephrology CKD-MBD and Dialysis working groups and CKD-MBD working group of the ERA-EDTA
Nephrology Dialysis and Transplantation, November 2020

European Consensus Statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4–G5D
Nephrology Dialysis Transplantation, October 2020

Cinacalcet use in paediatric dialysis: a position statement from the European Society for Paediatric Nephrology and the Chronic Kidney Disease-Mineral and Bone Disorders Working Group of the ERA-EDTA
Nephrology Dialysis Transplantation, October 2019 –  Click here to watch the related NDT Author video

Novel insights into parathyroid hormone: report of The Parathyroid Day in Chronic Kidney Disease
Clinical Kidney Journal, July 2018

Bone and mineral disorders in chronic kidney disease: implications for cardiovascular health and ageing in the general population
The Lancet Diabetes & Endocrinology, October 16, 2017

Bone in CKD: why the ERA EDTA CKD-MBD working group organized a dedicated meeting?
Journal of Nephrology, September 2017

The role of phosphate in kidney disease
on behalf of the ERA–EDTA Working Group on Chronic Kidney Disease–Mineral and Bone Disorders and the European Renal Nutrition Working Group,
Nature Reviews Nephrology, November 2016

Adynamic bone disease is a predominant bone pattern in early stages of chronic kidney disease
Journal of Nephrology, April 2017

The use of bone mineral density measured by dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed microtomography in chronic kidney disease
Journal of Nephrology, September 2017

Update on the role of bone biopsy in the management of patients with CKD–MBD
Journal of Nephrology, August 2017

Evaluation of fracture risk in chronic kidney disease
Journal of Nephrology, April 2017

Circulating markers of bone turnover
Journal of Nephrology, May 2017

Clinical practice recommendations for native vitamin D therapy in children with chronic kidney disease Stages 2–5 and on dialysis
Nephrology Dialysis Transplantation, May 2017

Clinical practice recommendations for treatment with active vitamin D analogues in children with chronic kidney disease Stages 2–5 and on dialysis
on behalf of the European Society for Paediatric Nephrology Chronic Kidney Disease Mineral and Bone Disorders and Dialysis Working Groups.
Nephrology Dialysis Transplantation, July 2017

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease
for the European Renal Nutrition (ERN) and Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Working Groups of the European Renal Association–European Dialysis Transplant Association (ERA-EDTA)
Journal of Cachexia, Sarcopenia and Muscle, July 2017

Bone biopsy practice patterns across Europe: the European renal osteodystrophy initiative—a position paper
Nephrology Dialysis Transplant, March 2017

Vitamin D in Chronic Kidney Disease
edited by Pablo A. Ureña, Mario Cozzolino and MG Vervloet (Springer)

Magnesium-based interventions for normal kidney function and chronic kidney disease
Magnesium Research, December 2016

Lack of evidence does not justify neglect: how can we address unmet medical needs in calciphylaxis?
on behalf of ERA-EDTA Working Group on CKD-MBD and EUCALNET.
Nephrology Dialysis Transplantation,  2016

Should patients with CKD stage 5D and biochemical evidence of secondary hyperparathyroidism be prescribed calcimimetic therapy? An ERA-EDTA position statement.
Chronic Kidney Disease-Mineral Bone Disease (CKD-MBD) working group and the European Renal Best Practice (ERBP) advisory board.; Chronic Kidney Disease-Mineral Bone Disease CKD-MBD working group and the European Renal Best Practice ERBP advisory board.
Nephrology Dialysis Transplantation, March 15

Pro: cardiovascular calcifications are clinically relevant.
Nephrology Dialysis Transplantation, February 2015

Opponent’s comments.
Nephrology Dialysis Transplantation, February 2015

Blueprint for a European calciphylaxis registry initiative: the European Calciphylaxis Network (EuCalNet)
Clinical Kidney Journal,  July 2015

Mineral Bone Disorder Is a Key Player in Chronic Kidney Disease
Seminars in Nephrology, November 2014

UPDATES FROM RECENT PUBLICATIONS IN THE FIELD

CKD-MBD related publications in the ERA journals

(more reports on CKD-MBD related publications are available at the botton of this section)

The ERA acknowledges the high clinical and scientific relevance of the CKD-MBD syndrome, reflected by several key publications in the journals of our society. We hereby summarize the content of several recent important papers, providing a link to their abstracts.

From July 2021 to the present review, 36 CKD-MBD related articles, including editorial comments and experimental studies, have been published; 19 in Nephrology Dialysis and Transplantation and 17 in the Clinical Kidney Journal (some only available in advance form).

1) Several reports dealt with vascular calcification (VC). N. Seyahi et al (Clin Kidney J 15 (1): 101-108) examined coronary artery calcification (CAC) progression and long-term cardiovascular outcomes in kidney transplant (KT) recipients. They found that CAC at baseline and CAC progression robustly predicted the risk of death and cardiovascular events in these patients.  E. Guillén-Olmos et al (Clin Kidney sfab205) analyzed their local series of calciphylaxis in KT recipients with a functioning graft, emphasizing that calciphylaxis can still occur after KT, in many cases during the first year and in patients with a good renal function. On the other hand, B. Van Berkel et al (Clin Kidney J 15 (2): 295-302) aimed to define the prevalence, progression and implications of breast artery calcification (BAC) in female patients with CKD across various stages of disease [CKD G2–5D-5T). They found that BAC was common among CKD patients (34.7%), progressed at a slower pace in KT patients as compared with CKD 5D, and associated with dismal cardiovascular outcomes. BAC score, kidney function, serum phosphate at baseline and vitamin K usage seemed to be important determinants of progression.  However, vitamin K supplementation improved vitamin K status, but did not hinder or modify the progression of arterial calcification in dialysis patients in the RenaKvit trial by K. Levy-Schousboe et al (Clin Kidney J 14 (9): 2114-2123). In another study, the associations of plasma dp-ucMGP (matrix-Gla protein)  with incident CKD and microalbuminuria were driven by the respective baseline effects of renal function and age according to D. Groothof et al (Nephrol Dial Transplant 36 (12): 2290-2299). All the potential beneficial effects of vitamin K supplementation were reviewed by M. Ketteler et al (Nephrol Dial Transplant 36 (12): 2196-2198).

2) Clustering phosphate and iron-related markers and prognosis in dialysis patients was studied by H. Morooka et al (Clin Kidney J 15 (2): 328-337) using unsupervised machine learning methods. Authors found that the use of phosphate binders was associated with a lower risk of all-cause death in two clusters which were characterized by older age and higher prevalence of diabetes mellitus, among other factors. M. Vervloet et al (Clin Kidney J 14 (7): 1770-1779) published an European real-world prospective observational study on the safety and effectiveness of sucroferric oxyhydroxide for treatment of hyperphosphatemia in dialysis patients. Efficacy and safety of PT20, another iron-based phosphate binder, were published by M. Sampson et al (Nephrol Dial Transplant 36 (8): 1399-1407) in a Phase IIb study in hemodialysis patients. K. McCullough et al (Clin Kidney J 14 (8): 1886-1893) reported the DOPPS study-based association between European hemodialysis patient satisfaction with phosphate binders with serum phosphate levels, and M. Cozzolino et al (Clin Kidney J 14 (8): 1859-1860) published a related editorial comment advocating the need of an individualized choice as a desirable option to improve the poor adherence associated with these medications. Enhancing motivation and adherence to dietary recommendations in CKD patients was reviewed by R.A. Pereira et al (Nephrol Dial Transplant 36 (12): 2173-2181).

On the other hand, early recognition, prevention and a multidisciplinary approach to hypophosphatemia is essential in the cancer patient according to S. Adhikari et al (Clin Kidney J. 14 (11): 2304-2315). Finally, L.D. Dubourg et al (Nephrol Dial Transplant, gfab331) described tubular phosphate handling reference values (TmP/GFR) from child to adulthood in the era of IDMS-standardized serum creatinine.

3) P. Ureña-Torres et al (Nephrol Dial Transplant, gfab308) commented on a previous report (M. Bozic et al.) regarding the independent effects of hyperphosphatemia and secondary hyperparathyroidism (SHPT) on CKD progression and cardiovascular events. Higher serum phosphate was also independently associated with kidney disease progression in IgA nephropathy as reported by G. Yu et al (Clin Kidney J 14 (9): 2108-2113), and the susceptibility for adverse health outcomes of patients developing sHPT in CKD was underlined by Y. Xu et al (Clin Kidney J 14 (10): 2213-2220). These authors described that incident sHPT was associated with increased risk of death, higher risk of MACEs, CKD progression and fractures. In their commentary, P. Ureña-Torres et al (Nephrol Dial Transplant, gfab308) also underlined the need to establish cut-off points for a safe high PTH level in non-dialysis patients and questioned whether reservation of active vitamin D analogues only for severe SHPT was exceedingly cautious. However, a systematic review and meta-analysis by M. Cozzolino et al (Clin Kidney J 14 (11): 2437-2443) warned about the risk of hypercalcaemia in non-dialysis CKD patients with SHPT treated with active vitamin D. J. Bover et al (Clin Kidney J 14 (10): 2177-2186) published a meta-analysis on the impact of nutritional vitamin D (NVD) supplementation. Their results suggested that NVD could be used to increase 25(OH)D to a certain extent, while the potential of NVD to actively reduce PTH in non-dialysis-CKD patients with SHPT was limited. R. de Alarcón et al (Nephrol Dial Transplant, gfab353) reported on the pharmacogenetic role of vitamin D-binding protein and vitamin D receptor polymorphisms in the treatment response of dialysis patients with SHPT. Two cases of severe hypercalcemia early after KT in two patients with severe SHPT previously treated with etelcalcetide was reported by G. Dachy et al (Clin Kidney J 14 (8): 1977-1979). Finally, gradual implementation of therapeutic advances over the last decade (including non-calcium phosphate binders, cinacalcet and vitamin D3, among other changes) was associated with a parallel reduction in short-term risk of death and MACE among Swedish hemodialysis patients according to M. Evans et al (Nephrol Dial Transplant 36 (7): 1298-1306).

4) Regarding bone disease, A.D. Lalayiannis et al (Nephrol Dial Transplant 36 (10): 1872-1881) reported that routinely used biomarkers but not DXA, were moderate predictors of cortical bone mineral density (BMD), measured by peripheral quantitative computed tomography, and therefore DXA should not be routinely performed in children and young adults with CKD 4–5D. R. Hiramatsu et al (Nephrol Dial Transplant 36 (10): 1900-1907) reported a 2-year observational non-controlled study where high bone turnover was an independent risk factor for denosumab-induced hypocalcemia, and that denosumab significantly increased BMD at lumbar spine and femoral neck. Wnt signalling inhibitors such as sclerostin and DKK1 circulating levels were associated with low-turnover bones disease in patients with CKD G3-G4  according to R. Neto et al (Clin Kidney J 14 (11): 2401-2408). Patterns of renal osteodystrophy 1 year after KT were described by H.S. Jørgensen et al (Nephrol Dial Transplant 36(11): 2130-2139). The majority of KT recipients, including patients with osteoporosis (15-46%), had normal bone turnover.

5) The intersection of mineralocorticoid receptor activation (MRA) and the FGF23–Klotho cascade promotes renal and cardiovascular injury through multipronged, albeit complementary, mechanistic pathways, according to M. Epstein and M. Freundlich (Nephrol Dial Transplant 37 (2): 211-221)A. Kale et al (Nephrol Dial Transplant, gfab340) focused on how the renin-angiotensin-aldosterone system and endoplasmic reticulum stress connect with Klotho regulation in kidney disease. They also highlighted novel approaches to implement Klotho as a therapeutic target.

6) Phosphate binders were included in the 2020 update on basic kidney research by C. Li and H-J Anders (Nephrol Dial Transplant 36 (7): 1145-1147). In miscellaneous experimental studies, A. Neradova et al (Nephrol Dial Transplantation gfab314) showed that neither phosphate binder therapy nor vitamin K2 supplementation alone prevented VC. However, the combination of high vitamin K2 with phosphate binder treatment significantly attenuated VC. A chronic high phosphate intake in mice did not cause major renal alterations, but affected negatively bone health, increasing bone resorption and decreasing bone mineral density as reported by M. Ugrica et al (Nephrol Dial Transplant 36 (7): 1183-1191). Y. Nishiguchi et al (Nephrol Dial Transplant 37 (3): 444-453) demonstrated that osteocrin, a bone-derived humoral factor, exerts a renoprotective role in ischemia–reperfusion injury in mice, and A.S. Shankar et al (Nephrol Dial Transplant 37(1):190-193) reported on the utility of human kidney organoids to study vitamin D metabolism. P. Ciceri et al (Clin Kidney J 14 (7): 1798-1807) published promising preliminary data on the effects of uremic serum from patients treated with expanded hemodialysis (Theranova 400) on VC in vitro.

7) Finally, a phenotype-driven genetic panel for the genetic evaluation of a paediatric patient with nephrocalcinosis was performed by J. Patterson et al (Clin Kidney J, sfab279) and revealed a rare association of Bartter syndrome type II and amelogenesis imperfecta.  A. Janiec et al (Nephrol Dial Transplant 36 (8): 1484-1492) described the long-term outcome of the survivors of infantile hypercalcaemia with CYP24A1 and SLC34A1 mutations (greater risk of progressive CKD and nephrocalcinosis).

Jordi Bover and Sandro Mazzaferro

on behalf of the CKD-MBD Working Group

Acknowledgement: Raul Sánchez-Marín for his valuable assistance.

Visit also:

CKD-MBD related publications January to June 2021

CKD-MBD related publications July to December 2020

CKD-MBD related publications January to June 2020

CKD-MBD related publications July to December 2019

More ‘CKD-MBD related publications’ reportsa are available in the ‘Newsletters’ section and accessible by clicking the pertaining newsletter link.

ONGOING PROJECTS

  • EUropean Renal OsteoDystrophy (EUROD):  This bone-biopsy network aims at joining nephrologists, endocrinologists and pathologists (Coordinator: Pieter Evenepoel). It is expected to collect the largest possible bone samples to be examined homogeneously, in order to improve knowledge on the role of bone in systemic disease CKD-MBD risk prediction score development. A web based registry, educational activities, training fellowships are part of the activities carried out by the group. Steering Committee: P. Evenepoel, M. Vervloet, S. Mazzaferro, P. D’Haese, J. Bacchetta, J. Cannata-Andia, A. Ferreira, M. Haarhaus, MH Lafage Proust, S. Salam S, G. Spasovski.
  • Concerted Action in Renal Osteosdystrophy (CAiRO): This project consists of a population-based cohort study and a pilot biomarker study. It builds on unique epidemiological resources and cutting-edge analytical expertise, already available within the European-ROD (EUROD) initiative.
  • European Calciphylaxis registry (Eucalnet): ongoing. More updates will be posted soon.
  • CKD-MBD risk prediction score development: project aims at evaluating data from large registries to develop a score to identify independent risk of several CKD-MBD phenotypes.
  • CKD-MBD was invited by ESPN (chaired by Dr Justine Bacchetta) to join the committee to develop the guideline for the use of calcimimetics in children. Read more.
  • CKD-MBD phenotypes and all cause mortality. Collaboration with EuroDOPPS. Steering committee: M. Vervloet, Z. Massy, M. Cozzolino, A. Bellasi, T. Hoekstra. The analysis has been run by Dr D. Siriopol (Romania).

WEBCASTS

5th European Renal Osteodystrophy (EUROD) Winter Meeting – January 20-21, 2022

Click here to watch the webcast of the event


Bone biopsy: when and how – January 11, 2022
ERA WG e-seminar series #17 – organised by CKD-MBD
Click here to watch the webcast of the event

 


Treatment of secondary hyperparathyroidism in non-dialysis CKD – November 2, 2021

ERA WG e-seminar series #13 – organised by CKD-MBD
Click here to watch the webcast of the event


How to limit vascular calcification and treat calciphylaxis – February 18, 2021
ERA WG e-seminar series #2 – organised by CKD-MBD
Click here to watch the webcast of the event


4th European Renal Osteodystrophy (EUROD) Winter Meeting – January 14-15, 2021

Click here to watch the webcast of the event


Nephrology Virtual Preceptorship: Fracture Prevention in CKD – December 4, 2020
Click here to watch the webcast of the event

PAST ACTIVITIES

5th European Renal Osteodystrophy (EUROD) Winter Meeting – January 20-21, 2022
Click here to watch the webcast of the event

4th European Renal Osteodystrophy (EUROD) Winter Meeting – January 14-15, 2021
Click here to watch the webcast of the event

Nephrology Virtual Preceptorship: Fracture Prevention in CKD–  December 4, 2020
Click here to watch the webcast of the event

3rd European Renal Osteodystrophy (EUROD) Winter meeting – January 18, 2020 – Leuven, Belgium

The challenge of osteoporosis in CKD – January 18, 2019 – Leuven, Belgium

EURECA-m and CKD-MBD meeting – September 13-15, 2018 – Thessaloniki, Greece

The role of bone biopsy in clinical practice – January 19, 2018 – Leuven, Belgium

The parathyroid hormone (PTH) day in chronic kidney disease (CKD) from bench to bedside – September 8, 2017 – Paris, France

The Bone in Chronic Kidney Disease Symposium – September 23, 2016 – Amsterdam, Netherlands

NEWSLETTERS

CKD-MBD Newsletter #24, 2022

CKD-MBD Newsletter #23, 2022

CKD-MBD Newsletter #22, 2021

CKD-MBD Newsletter #21, 2021 – including CKD-MBD related publications in the field (January – June 2021)

CKD-MBD Newsletter #20, 2021 – including CKD-MBD related publications in the field (January – June 2020 and July to December 2020)

CKD-MBD Newsletter #18, 2019

CKD-MBD Newsletter #17, 2019

CKD-MBD Newsletter #16, 2019  – including CKD-MBD related publications in the field (July – December 2019)

CKD-MBD Newsletter #14-15, 2018

CKD-MBD Newsletter #13, 2018

CKD-MBD related publications #12 (Nephrol Dial Transplant and Clin Kidney J)

CKD-MBD Newsletter #11, 2018

CKD-MBD Newsletter #10, 2018
CKD-MBD related publications #10 (Nephrol Dial Transplant and Clin Kidney J)

CKD-MBD Newsletter #9 (1), 2018

CKD-MBD related publications #9 (Nephrol Dial Transplant and Clin Kidney J)

CKD-MBD Newsletter #8 (2), 2017
CKD-MBD related publications #8 (Nephrol Dial Transplant and Clin Kidney J)

CKD-MBD Newsletter #7 (1), 2017
CKD-MBD related publications #7 (Nephrol Dial Transplant and Clin Kidney J)

CKD-MBD Newsletter #6 (2), 2016
CKD-MBD related publications #6 (Nephrol Dial Transplant and Clin Kidney J)

CKD-MBD Newsletter #5 (1), 2016
CKD-MBD related publications #5 (Nephrol Dial Transplant and Clin Kidney J) 

CKD-MBD Newsletter #4 (2), 2015
CKD-MBD related publications #4 (Nephrol Dial Transplant and Clin Kidney J) 

CKD-MBD Newsletter 3, 2015
CKD-MBD related publications #3 (Nephrol Dial Transplant and Clin Kidney J)

CKD-MBD Newsletter 2, 2014

CKD-MBD Newsletter 1, 2013