The purpose of this article is to review the basic pathophysiological events leading to renal osteodystrophy and how continuous ambulatory peritoneal dialysis may alter these processes. This form of therapy has significant effects on mineral homeostasis and may, under some circumstances, alter vitamin D and parathyroid hormone metabolism. Some short-term studies suggest that there may be an improvement in bone histology during treatment. Although much remains to be learned about renal osteodystrophy and continuous ambulatory peritoneal dialysis, enough information is currently available to allow implementation of a rational plan of therapy that should optimize mineral metabolism.