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PTH Mild Elevation CKD Trends Matter — ESENeph MCQ

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ModerateChronic Kidney DiseasePTH Mild Elevation CKD Trends MatterESENeph

A 50-year-old man with CKD G3b has an elevated parathyroid hormone of 15 pmol/L with calcium 2.25 mmol/L and phosphate 1.6 mmol/L. His 25-OH vitamin D is replete (85 nmol/L). Should he be treated for secondary hyperparathyroidism?

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Correct answer: A — In CKD G3a-G5 (not on dialysis) as the next step

KDIGO 2017 CKD-MBD states that for CKD G3a-G5 (not on dialysis), the optimal PTH level is not known. The guideline suggests: (1) evaluating modifiable factors (vitamin D deficiency, hyperphosphataemia, hypocalcaemia); (2) trends are more important than single values; (3) markedly elevated or progressively rising PTH warrants intervention. A single mildly elevated PTH (15 pmol/L, approximately 2x ULN) with replete vitamin D, controlled phosphate, and normal calcium may warrant monitoring rather than treatment. This avoids unnecessary medication and potential PTH oversuppression.

Reference: https://guidelines.ukkidney.org