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Menaka Sarav and Stuart M. Sprague

During the 1980s and 1990s, the focus of dealing with disorders of bone and mineral metabolism was predominantly “bone centric,” with parathyroid hormone (PTH) the main culprit and calcium the primary regulator of PTH. The term “renal osteodystrophy” was generally used to encompass these disorders. The focus of therapy was to maintain relatively high serum calcium concentrations in order to suppress PTH, which would presumably result in normal bone. This strategy did result in decreased PTH concentrations with the use of relatively high dialysate calcium baths, calcium-based phosphate binders and calcitriol; however, this practice resulted in hypercalcemia. As a result,