Link to excel spreadsheet converting VitD and Epo analogs

The Role of Vitamin D in CKD Stages 3 to 4: Report of a
Scientific Workshop Sponsored by the National Kidney
Foundation (2018 AJKD PDF)

• the panel agreed that clinicians should classify 25(OH)D adequacy as concentrations > 20 ng/mL without evidence of counterregulatory hormone activity (ie, elevated PTH).
• The panel also agreed that 25(OH)D concentrations < 15 ng/mL should be treated irrespective of PTH level.
• Patients with 25(OH)D concentrations between 15 – 20 ng/mL may not require treatment if there is no evidence of counter-regulatory hormone activity.
• The panel agreed that cholecalciferol may be preferable to ergocalciferol supplementation.

Treatment of CKD-MBD targeted at lowering high serum phosphate and maintaining serum calcium (KDIGO CKD-MBD 2017 Clinical Practice Guidelines)

• CKD G3a–G5D
  • treatment of CKD-MBD should be based on serial assessments of phosphate,
    calcium, and PTH levels, considered together (Not Graded).
  • suggest lowering elevated phosphate levels toward the normal range (2C).
  • suggest avoiding hypercalcemia (2C).
  • decisions about phosphate-lowering treatment should be based on progressively
    or persistently elevated serum phosphate (Not Graded).
  • suggest restricting the dose of calcium-based phosphate binders (2B).
  • suggest limiting dietary phosphate intake in the treatment of hyperphosphatemia alone or in combination with other treatments (2D).
  • reasonable to consider phosphate source (e.g., animal, vegetable, additives) in making dietary recommendations (Not Graded).
• ESKD on Dialysis
  • suggest using a dialysate calcium concentration between 1.25 and 1.50 mmol/l
    (2.5 and 3.0 mEq/l) (2C)

Treatment of abnormal PTH levels in CKD-MBD

• CKD G3a–G5 not on dialysis
  • the optimal PTH level is not known.
  • suggest that patients with levels of intact PTH progressively rising or persistently above the upper normal limit for the assay be evaluated for modifiable factors, including hyperphosphatemia, hypocalcemia, high phosphate intake, and vitamin D deficiency (2C).
  • suggest that calcitriol and vitamin D analogs not be routinely used (2C).
  • reserve the use of calcitriol and vitamin D analogs for patients with CKD G4–G5 with severe and progressive hyperparathyroidism (Not Graded).
• ESKD on Dialysis
  • for those requiring PTH-lowering therapy, we suggest calcimimetics, calcitriol, or vitamin D
    analogs, or a combination of calcimimetics with calcitriol or vitamin D analogs.