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Paricalcitol Selective VDRA Advantage — ESENeph MCQ

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HardChronic Kidney DiseaseParicalcitol Selective VDRA AdvantageESENeph

An adult with CKD G4 not receiving dialysis has PTH rising on serial measurements despite correction of vitamin-D deficiency and control of phosphate intake. Calcium and phosphate are now within their reference ranges. Which active-vitamin-D strategy best matches KDIGO?

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Correct answer: E — Reserve calcitriol or a vitamin-D analogue for severe, progressive hyperparathyroidism

The best answer is “Reserve calcitriol or a vitamin-D analogue for severe, progressive hyperparathyroidism”. KDIGO advises against routine calcitriol or vitamin-D analogues in non-dialysis CKD and reserves them for CKD G4-G5 with severe, progressive secondary hyperparathyroidism after modifiable drivers are corrected. “Start paricalcitol because it is preferred to every other active vitamin-D preparation” is less appropriate because KDIGO does not designate one vitamin-D receptor activator as universally superior “Start routine calcitriol for any PTH above the laboratory reference range” is less appropriate because modest isolated PTH elevation is not the non-dialysis treatment threshold “Increase phosphate intake before considering active vitamin D” is less appropriate because additional phosphate can aggravate CKD-mineral and bone disorder “Suppress PTH into the lower reference range as the primary target” is less appropriate because management follows serial trends and avoids excessive suppression and adynamic bone disease

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