When considering the CKD-MBD treatment of our country, we should take account of clinical background, such as a high ratio of long-term hemodialysis patients, a small number of renal transplantation surgeries, etc. Furthermore, insurance systems differ from country to country and the universal public insurance system will also have some influences on medical circumstances in Japan. Re-considering the CKD-MBD treatment of Japan from these perspectives, there remain some issues to be addressed ; a choice of which phosphate binder is the best, a selection of treatment for severe secondary hyperparathyroidism, cinacalcet or surgery. The issues about native vitamin D agent and the treatment for osteoporosis in CKD patients should be also resolved. This article argues the present situation of CKD-MBD treatment and considers new issues and problems for more sophisticated CKD-MBD therapy in Japan.