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Native Vitamin D Repletion CKD — ESENeph MCQ

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HardChronic Kidney DiseaseNative Vitamin D Repletion CKDESENeph

A patient with CKD G4 has low 25-hydroxyvitamin D, normal corrected calcium and phosphate, and only a modest stable PTH elevation. What is the appropriate first vitamin-D strategy?

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

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Correct answer: A — Native vitamin-D repletion with serial calcium, phosphate and PTH monitoring

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

E is correct. KDIGO advises measuring and correcting vitamin-D deficiency or insufficiency in CKD using strategies recommended for the general population. Calcitriol and active analogues are not routine in non-dialysis CKD; they are reserved for selected CKD G4–G5 patients with severe, progressive secondary hyperparathyroidism after modifiable factors have been addressed. A overuses active therapy and increases hypercalcaemia and phosphate risk. B incorrectly assumes absent nutritional activation. C withholds standard deficiency treatment. D lowers PTH but does not replace vitamin-D stores. Calcium, phosphate and PTH trends are followed rather than reacting to one modest value.

Reference: KDIGO 2017 CKD-MBD guideline update: https://kdigo.org/wp-content/uploads/2018/04/2017-KDIGO-CKD-MBD-GL-Update.pdf