CKD-MBD begins early in the course of kidney disease and consists of renal osteodystrophy, vascular calcification (VC), and cardiac disease together with elevations of plasma phosphate (P) and fibroblast growth factor 23 (FGF23) as well as decrease of klotho [46, 47, 55]. Here, FGF23 is linked to Marchiafava-Bignami disease.