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“In patients with CKD G3a–G5D, treatments of CKD–MBD should be based on serial assessments of phosphate, calcium, and PTH levels, considered together (Not Graded).”

“In patients with CKD G3a–G5 not on dialysis, the optimal PTH level is not known. However, we suggest that patients with levels of intact PTH progressively rising or persistently above the upper normal limit for the assay be evaluated for modifiable factors, including hyperphosphatemia, hypocalcemia, high phosphate intake, and vitamin D deficiency (2C).


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

KDIGO also mention that no studies of sufficient duration with nutritional vitamin D supplementation to suppress PTH could be identified, and “thus this therapy remains unproven.”

The full KDIGO 2017 clinical practice guidelines are available online.

View guidelines

The limitations of current treatment
options are acknowledged in KDIGO
2017 guidelines12

CKD: chronic kidney disease; CKD–MBD: chronic kidney disease–mineral and bone disorder; KDIGO: Kidney Disease—Improving Global Outcomes;

PTH: parathyroid hormone.