We examined whether patients receiving care in dialysis centers where greater proportions of patients have two or more values outside of the target range for PTH, calcium, and phosphate are at increased risk for clinically meaningful outcomes related to CKD-MBD, including cardiovascular hospitalization, mortality, parathyroidectomy, and a composite endpoint of all-cause mortality and cardiovascular hospitalization. This evidence concerns the gene PTH and Marchiafava-Bignami disease.