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7,77 Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication in which one or more of the following occur due to the loss of proper regulation by the kidneys: Abnormal bone mineralization, strength, growth, and turnover Calcification of non-bone tissues, including blood vessels Irregularities in vitamin D, calcium, phosphorus, fibroblast growth factor-23, and parathyroid hormone metabolism Each of these abnormalities is associated with a high risk of mortality, primarily attributable to the cardiovascular consequences

This is structurally analogous to semaglutide's fatty-acid tether but optimized for dual-receptor residency

Patients should be counseled about the risk of hypoglycemia, particularly if taking concomitant insulin or sulfonylureas, though tirzepatide's glucose-dependent mechanism reduces this risk compared to older diabetes medications