not recommend that there should be routine measurement of calcium, phosphate, parathyroid hormone (PTH) and vitamin D levels in people with stage 1, 2, 3A or 3B CKD
measure serum calcium, phosphate and PTH concentrations in people with stage 4 or 5 CKD (GFR less than 30 ml/min/1.73 m2). Determine the subsequent frequency of testing by the measured values and the clinical circumstances. Where doubt exists seek specialist opinion
bisphosphonates should be offered (if indicated) for the prevention and treatment of osteoporosis in people with stage 1, 2, 3A or 3B CKD
Vitamin D supplements in the management of CKD-mineral and bone disorders
do not routinely offer vitamin D supplementation to manage or prevent CKD-mineral and bone disorders
offer colecalciferol or ergocalciferol to treat vitamin D deficiency in people with CKD and vitamin D deficiency
if vitamin D deficiency has been corrected and symptoms of CKD-mineral and bone disorders persist, offer alfacalcidol (1-alpha-hydroxycholecalciferol) or calcitriol (1-25-dihydroxycholecalciferol) to people with a GFR of less than 30 ml/min/1.73 m2 (GFR category G4 or G5)
monitor serum calcium and phosphate concentrations in people receiving alfacalcidol or calcitriol supplements
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