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KDIGO 2017 icon

KDIGO 2017 guidelines for SHPT management

KDIGO 2017 guidelines for SHPT management

Download our KDIGO CKD–MBD Quick Reference Guide.


KDIGO recommends regular bone mineral and vitamin D monitoring in patients with CKD1

In stage 3 to 5 non-dialysis chronic kidney disease (ND-CKD) patients, Kidney Disease: Improving Global Outcomes (KDIGO) recommends the following.

  • Regular monitoring of serum levels of calcium, phosphate and parathyroid hormone (PTH) starting from stage 3A CKD (Figure 1)1
  • Measurement of 25(OH)D starting from stage 3A CKD, with repeated testing being determined by baseline values and therapeutic interventions1
  • After identifying patients with progressively rising PTH levels, evaluating them for modifiable risk factors, such as hyperphosphataemia, hypocalcaemia, high phosphate intake and vitamin D deficiency1
  • Basing therapeutic decisions on trends rather than on a single laboratory value, taking into account all available chronic kidney disease–mineral and bone disorder (CKD–MBD) assessments1
Figure 1. KDIGO monitoring guidelines for stage 3–5 ND-CKD patients1

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


KDIGO acknowledges the limitations of current SHPT treatments1

AVD and its analogues are not recommended for routine use in stage 3 and 4 CKD patients1

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



In adult patients with CKD G3a–G5 not on dialysis, we suggest that calcitriol and vitamin D analogs not be routinely used (2C[*]). It is reasonable to reserve the use of calcitriol and vitamin D analogs for patients with CKD G4–G5 with severe and progressive hyperparathyroidism.



NVD remains unproven1

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


Learn more about treatment options for SHPT in CKD

Footnotes, abbreviations and references

*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.

  1. Kidney Disease: Improving Global Outcomes (KDIGO) Work Group. Kidney Int Suppl. 2017;7:1–59.
  2. Wetmore JB et al. Kidney Int Rep. 2021;DOI:10.1016/j.ekir.2020.12.036.

Download our KDIGO CKD–MBD Quick Reference Guide.