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In CKD stages 3–5, progressively higher 25(OH)D levels are:20
- Associated with lower PTH concentrations
- Not associated with increased rates of hypercalcaemia or hyperphosphataemia
The effect of 25(OH)D to reduce PTH does not decrease until 25(OH)D levels of 42–48 ng/mL (105–120 nmol/L).20
“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).