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In stage 3 to 5 non-dialysis chronic kidney disease (ND-CKD) patients, Kidney Disease: Improving Global Outcomes (KDIGO) recommends the following.
No recommendation for FGF-23 to be measured in clinical practice.
Adapted from KDIGO 2017.1
Opportunities to treat abnormalities related to CKD–MBD and potentially avoid the development of bone and cardiovascular complications are often missed due to poor levels of adherence to KDIGO’s monitoring guidelines.2
According to KDIGO, due to the risk of hypercalcaemia, active vitamin D (AVD) and AVD analogues should be reserved for patients with stage 4 to 5 CKD and severe and progressive hyperparathyroidism.1
Whilst KDIGO suggests that nutritional vitamin D (NVD) should be used to address vitamin D deficiency and insufficiency in ND-CKD, it also acknowledges that no studies of sufficient duration are available, and thus the therapy remains unproven in patients with stage 3 to 4 CKD.1
*2C = A suggestion rather than a recommendation (2), with low quality of evidence (C).1
25(OH)D: 25-hydroxyvitamin D; AVD: active vitamin D; Ca: calcium; CKD: chronic kidney disease; CKD–MBD: chronic kidney disease–mineral and bone disorder; FGF-23: fibroblast growth factor-23; KDIGO: Kidney Disease–Improving Global Outcomes; ND-CKD: non-dialysis chronic kidney disease; PO: phosphate; PTH: parathyroid hormone; RRT: renal replacement therapy; SHPT: secondary hyperparathyroidism.
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