Isakova T, Cai X, Lee J, et al. - Researchers undertook this retrospective analysis nested in a cohort study, to characterize the longitudinal evolution of disordered mineral metabolism during the course of chronic kidney disease (CKD). They analyzed individuals who took part in the Chronic Renal Insufficiency Cohort Study and were examined via 5 serial annual measurements of estimated glomerular filtration rate, fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), serum phosphate, and serum calcium. These individuals subsequently reached end-stage kidney disease (ESKD) during follow-up (n = 847). They noted a marked rise in mean FGF-23 levels as time before ESKD reduced, while a modest rise in PTH and phosphate levels and a minimal decline in calcium levels was observed. The highest rate of change and magnitude of acceleration was displayed by FGF-23 levels than other mineral metabolites. Experts concluded that a rise in FGF-23 levels starts to happen 5 years prior to ESKD in patients with progressive CKD, and these levels keep on accelerating swiftly until transition to ESKD.