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From stage 1 CKD, where kidney damage may be the only indicator, to stage 5 CKD, where dialysis or a transplant is required, the treatments vary greatly. One of the first systems to be affected by CKD is 1\u2010\u03b1 hydroxylation of vitamin D by production of the enzyme in the kidney. Alterations in this system contribute to bone disorders that are manifested by mineral changes throughout the course of CKD. 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