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KIDNEY DISEASE, CHRONIC—MINERAL AND BONE DISORDERS (CKD-MBDS)

Population

  • –Adults and children.

Recommendations

2017 KDIGO CKD-MBD Guidelines

  • –Recommends monitoring serum calcium, phosphorus, immunoreactive parathyroid hormone (iPTH), and alkaline phosphatase levels:

    • Beginning with Stage G3a CKD (adults).

    • Beginning with Stage G2 CKD (children).

  • –Measure 25-OH vitamin D levels beginning in stage G3a CKD.

  • –Recommends treating all vitamin D deficiency with vitamin D supplementation with standard recommended dosing. Decisions to treat should be based on trends of vitamin D levels, not a single level.

  • –In Stages G3–5 CKD, consider a bone biopsy before bisphosphonate therapy if a dynamic bone disease is a possibility.

  • –In Stages G3–5 CKD, aim to normalize calcium and phosphorus levels.

  • –In Stage G5 CKD, seek to maintain a parathyroid hormone (PTH) level of approximately 2–9 times the upper normal limit for the assay.

Source

Comment

  1. Options for oral phosphate binders:

    1. Calcium acetate.

    2. Calcium carbonate.

    3. Calcium citrate.

    4. Sevelamer carbonate.

    5. Lanthanum carbonate.

KIDNEY DISEASE, CHRONIC

Population

  • –Adults.

Recommendations

2012 KDIGO, 2014 NKF-KDOQI

  • –Recommends the staging of CKD based on cause, GFR category and albuminuria category with abnormalities being present for at least 3 mo.

    • Cause: Assign cause of CKD based on absence or presence of systemic disease and the location within the kidney of observed or presumed pathologic-anatomic abnormalities.

    • GFR category

      • G1: GFR >90 (mL/min/1.73 m2)

      • G2: GFR 60–89

      • G3a: GFR 45–59

      • G3b: GFR 30–44

      • G4: GFR 15–29

      • G5: GFR <15

    • Albuminuria category

      • A1: ACR (urine albumin-to-creatinine ratio) <3

      • A2: ACR 3–30

      • A3: ACR >30

  • –Recommends using creatinine and GFR estimating equation for initial assessment.

  • –Evaluation for chronicity.

    • In those with GFR <60 mL/min/1.73 m2 (GFR categories G3a–5), evaluate history of prior indicators for kidney disease and prior measurements.

    • If duration is >3 mo then CKD is confirmed. If not >3 mo CKS is not confirmed or is unclear.

  • –Assess GFR and albuminuria at least annually for people with CKD. Assess more frequently for those at higher risk for progression. For people with CKD G3a measure serum cystatin C and calculate GFR using a GFR estimating equation and cystatin C if the confirmation of CKD is required.

  • –Management of disease progression.

    • Control BP and individualize BP targets based on age, coexisting comorbidities, presence of retinopathy, and tolerance of treatment.

    • Recommend that an ACE-I or ARB be used in diabetic patients with CKD and urine albumin excretion of 30–300 mg/24 h (or equivalent).

    • Suggest lowering protein intake to 0.8 g/kg/d in adults with diabetes and nondiabetics with GFR categories G4–5.

    • Recommend a large hemoglobin A1C of approximately 7% in people with diabetes and CKD.

    • Recommend a salt intake of <2 g/24 h in people with CKD.

  • –Recommends at least once a check of serum calcium, phosphate, intact parathyroid hormone, 25-OH vitamin D, and hemoglobin ...

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