Guidelines for non-dialysis patients with CKD-MBD

I Measure items and frequencies

1) The recommended serum P, Ca, PTH, ALP values ​​were measured from CKD3 (1C).

2) Serum P, Ca, ALP value of the measurement frequency is CKD3 every 6 to 12 months, CKD4 every 3 to 6 months, CKD5 every 1 to 3 months (no grade).

3) PTH values ​​measured in CKD3 every 12 months, CKD4 every 6 to 12 months, CKD5 every 3 to 6 months once (no grade).

4) Bone mineral density examination and bone metabolism indicators of the measurement, CKD1 ~ 2 patients and patients without biochemical abnormalities in CKD3 patients, and the general population (2B).

5) non-dialysis CKD patients with bone biopsy, consistent with dialysis patients (no grade)

Management objectives and treatment

1. Management of serum P and Ca

1) Serum P and Ca values ​​were maintained within the clinical target range (2C).

2) Serum P management, dietary intake of P and oral P adsorbent treatment (no grade).

3) serum Ca management, taking CaP-containing adsorbents and oral active vitamin D, the dose according to the inpidual clinical adjustment of patients (no grade).

2. PTH management

1) When PTH exceeds the target value, it should be corrected (no level).

2) limit the use of P, P adsorbents in the diet, oral active vitamin D (no grade).

3. How to prevent the occurrence of fractures, CKD1 ~ 2 patients, and the general population recommended the same treatment of osteoporosis (1A). Patients with CKD3 without biochemical abnormality, the same treatment regimen as the general population (2B)

CKD early, due to PTH and fibroblast growth factor (fibroblast growth factor-23, FGF-23) and other effects, serum P remained in the normal range [with the progress of renal function, P accumulation is more significant. The rise of PTH in patients with CKD began to occur from CKD2 to phase 3, with high P and hypokalemia occurring from CKD4. These measurements were recommended from CKD3 and the same frequency as KDIGO guideline [2].

The target value of blood P value for patients with non-dialysis CKD was set within the target value set clinically. Treatment and dialysis patients are not very different.

The management of serum Ca in patients with non-dialysis CKD was similar to that in dialysis patients. When combined with hypercalcemia, consider whether it is associated with malignancy and primary hyperparathyoidiam (PHPT).

SHPT from the early onset of CKD, non-dialysis CKD patients with high conversion of bone disease reasons, need to be managed, including the existence of P accumulation, vitamin D deficiency (or lack) and so on.

This guideline is the same as the KDIGO guideline [2] for management objectives of PTH in non-dialysis CKD patients.

Alendronate, raloxifene hydrochloride, teriparabine and so on for CKD 1 to 2 and without biochemical abnormalities in CKD 3 patients can reduce the risk of fracture. However, for the presence of biochemical abnormalities in CKD 3 and CKD 4 to 5 patients, the effectiveness of these drugs has not been fully validated.