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PTH Target Range CKD-MBD — ESENeph MCQ

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ModerateChronic Kidney DiseasePTH Target Range CKD-MBDESENeph

A 50-year-old man with CKD G4 (eGFR 18) and secondary hyperparathyroidism has PTH 65 pmol/L. His phosphate is controlled (1.5 mmol/L), calcium is 2.2 mmol/L, and 25-OH vitamin D is replete. He is on Alfacalcidol 0.5 mcg. What PTH range does KDIGO 2017 suggest is appropriate for CKD G5/G5D?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — 2-9 times the upper limit of normal of the assay

KDIGO 2017 CKD-MBD guideline suggests maintaining PTH in the range of approximately 2-9 times the upper limit of the normal assay range for CKD G5D. If the upper limit of normal is ~7 pmol/L, the suggested range is approximately 14-63 pmol/L. This patient's PTH of 65 pmol/L is only marginally above this range. The key principle is to avoid both excessively high PTH (osteitis fibrosa) and excessively low PTH (adynamic bone disease). Trends are more important than single values.

Reference: KDIGO 2017 – CKD-MBD Guideline Update