What PTH Levels Are Appropriate?
Returning to the question as to what levels of PTH can be considered adequate in non-dialyzed CKD patients, the K/DOQI guidelines on bone and mineral metabolism [17] that have been used as an international reference over the last 6 years recommend serum iPTH levels of 35–70 pg/ml for stage 3 CKD, 70–110 pg/ml for stage 4 and 150–300 pg/ml for stage 5 and dialysis. It is important to note that the recommendations concerning stage 3–4 CKD are based on expert advice. The more recent KDIGO guidelines on Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) [18] more prudently state that ‘in patients with CKD stages 3–5 not on dialysis, the optimal PTH level is not known’, and suggest finding and treating hyperphosphatemia, hypocalcemia and vitamin D deficiency in patients with above-normal iPTH levels. Treatment with calcitriol or vitamin D analogues is recommended if serum PTH levels are progressively increasing and remain above the upper normal limit despite the correction of any ot
