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KIDNEY DISEASE, CHRONIC—MINERAL AND BONE DISORDERS (CKD-MBDS)
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2017 KDIGO CKD-MBD Guidelines
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–Recommends monitoring serum calcium, phosphorus, immunoreactive parathyroid hormone (iPTH), and alkaline phosphatase levels:
–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.
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Options for oral phosphate binders:
Calcium acetate.
Calcium carbonate.
Calcium citrate.
Sevelamer carbonate.
Lanthanum carbonate.
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KIDNEY DISEASE, CHRONIC
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2012 KDIGO, 2014 NKF-KDOQI
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–Recommends the staging of CKD based on cause, GFR category and albuminuria category with abnormalities being present for at least 3 mo.
–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 ...