This protocol addresses patients with chronic kidney disease (CKD G3a–G5) who are not on dialysis and whose intact PTH is progressively rising or persistently above the upper limit of normal for the assay used.
In patients with CKD G3a–G5 not on dialysis, the optimal intact PTH target is not known. When PTH is progressively rising or persistently above normal, the recommended first step is to evaluate for modifiable contributing factors—including hyperphosphatemia, hypocalcemia, elevated dietary phosphate intake, and vitamin D deficiency—before any further escalation.
Management is directed at identifying and correcting the modifiable factors found on evaluation, through dietary measures and targeted nutritional or supplementation strategies. The complete protocol details which interventions apply, in which combinations, and under what clinical circumstances.
Intact PTH no longer progressively rising; correction of hyperphosphatemia, hypocalcemia, and vitamin D deficiency.
DOI: 10.1038/ki.2009.191
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).
It is reasonable to correct these abnormalities with any or all of the following: reducing dietary phosphate intake and administering phosphate binders, calcium supplements, and/or native vitamin D (Not Graded).
We suggest that vitamin D deficiency and insufficiency be corrected using treatment strategies recommended for the general population (2C).
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