Table 1:

Evolution of guidelines on the treatment and therapy of abnormal PTH levels in non-dialysis CKD patients.

KDOQI 2003 [10]	KDIGO 2009 [2]	KDIGO 2017 [3]
Guideline 8A.1	Guideline 4.2.2	Guideline 4.1.4
In patients with CKD stages 3 and 4, therapy with an active oral vitamin D sterol (calcitriol, alfacalcidol or doxercalciferol) is indicated when serum levels of 25(OH)D are >30 ng/ml (75 nmol/L) and plasma levels of iPTH are above the target range for the CKD stage a	In patients with CKD stages 3–5 not on dialysis, in whom serum PTH is progressively rising and remains persistently above the ULN for the assay despite correction of modifiable factors, we suggest treatment with calcitriol or vitamin D analogues (2C)	In patients with CKD stages 3a–5 not on dialysis, we suggest calcitriol and vitamin D analogues not be routinely used (2C). It is reasonable to reserve their use for patients with CKD stages 4–5 with severe and progressive hyperparathyroidism (not graded)

^aCKD stage 3: 35–70 pmol/l (opinion); CKD stage 4: 70–110 pmol/l (opinion); CKD stage 5: 150–300 pmol/l (evidence).