Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) is driven by impaired phosphate excretion resulting in both bone disease and vascular calcification, which, in turn, mediates increased arterial stiffness and adverse LV remodeling.27, 28 Markers of CKD-MBD such as phosphate, fibroblast growth factor 23 (FGF-23), and parathyroid hormone (PTH) predict mortality and adverse cardiovascular events in patients with CKD.29 This evidence concerns the gene FGF23 and Marchiafava-Bignami disease.