Table 4.
Targets for parathyroid hormone (PTH).
| CKD Stage |
KDIGO (2009) (Chapter 4.2 ) |
KDOQI (2003) (Guideline 1) |
Author opinion |
|---|---|---|---|
| 5D | Suggest maintaining intact PTH levels in the range of approximately 2–9 times the ULN for the assay. Suggest that marked changes in either direc- tion within this range prompt an initiation or change in therapy to avoid progression to levels out- side of this range |
150–300 pg/ml (16.5–33.0 pmol/l) |
Evaluate trends in circu- lating PTH to guide ther- apy, with a general goal of a stable and lower PTH than prior to treat- ment, and normalization of alkaline phosphatase or bone-specific alkaline phosphatase |
| 5 | Suggest that patients with levels of intact PTH above the ULN of the assay are first evaluated for hyperphosphatemia hypo- calcemia and vitamin D defi- ciency, and if present these ab- normalities should be corrected In patients in whom PTH is pro- gressively rising and remains persistently above the ULN for the assay despite correction of modifiable factors, treatment with calcitriol or vitamin D analogs is suggested |
||
| 4 | 70–110 pg/ml (7.7–12.1 pmol/l) |
||
| 3 | 35 – 70 pg/ml (3.85–7.7 pmol/l) |
KDIGO = kidney disease improving global outcomes; KDOQI = kidney disease outcomes quality initiative; CKD = chronic kidney disease; ULN = upper limit of normal.