Mineral Metabolism Targets: Stage 3 eGFR = 30-59 (mL/min/1.73m2)

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia

Biochemical and Haematological Targets
2006

Serum Calcium:
Should be kept within the normal laboratory reference range. (Opinion)

Biochemical Targets- Calcium

Serum Phosphorus:
Should be kept within the normal laboratory reference range. (Opinion)

Biochemical Targets – Serum phosphate

A fasting blood sample should be used. (Level III
evidence)

CSN - Canada

EBGP-Europe

Europe:  Clinical Algorithms presented by an expert panel not in the context of EBPG
2001

Phosphorus:
2.5-4.6 mg/dl or 0.8-1.5 mmol/L (Opinion)

Clinical algorithms on renal osteodystrophy

Page 5 of 19 website PDF

Calcium:
8.8-11 mg/dl or 2.2-2.7 mmol/L (Opinion)

PTH:
85-170 pg/ml  or 9-18 pmol/L (Opinion)

KDOQI – US

Bone Metabolism and Disease in Chronic Kidney Disease
2003

Phosphorus:
2.7-4.6 mg/dl or 0.9-1.5 mmol/L (Opinion)

Guideline 3. Evaluation of serum phosphorus levels

Calcium:
"normal, preferably toward the lower end"
8.4-9.5 mg/dl or 2.1-2.37 mmol/L (Opinion)

Guideline 6. Serum calcium and calcium-phosphorus product

PTH:
35-70 pg/ml or 3.9-7.7 pmol/L (Opinion)

Guideline 1. Evaluation of calcium and phosphorus metabolism

See Table 15

UK-Renal Association

Module 2: Complications of CKD

2007

Mineral and Bone Disorders

- Serum phosphate in patients with CKD stages 3 and 4 should be maintained between 0.9 and 1.5 mmol/L. (Evidence)

- The serum albumin corrected calcium phosphorus product should be kept below 4.8 mmol2/L2 and ideally below 4.2 mmol2/L2 in all CKD patients. (Evidence)

- The target range for parathyroid hormone measured using an intact PTH should increase from the normal range with CKD stages 1-3, to between the top of the normal range and twice normal for stage 4 CKD and to between 2 to 4 times normal in CKD stage 5 not on dialysis. (Good practice)