KDIGO 2017 Clinical Practice Guideline Update for …

1 OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGYVOLUME 7 | ISSUE 1 | JULY 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease Mineral and Bone Disorder (CKD-MBD) 131-05- 2017 13:23:0531-05- 2017 13:23:05 KDIGO 2017 Clinical Practice Guideline UPDATEFOR THE DIAGNOSIS, EVALUATION, PREVENTION, ANDTREATMENT OF CHRONIC KIDNEY DISEASE MINERAL ANDBONE DISORDER (CKD-MBD)Kidney International Supplements( 2017 )7, 1 591 KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis,Evaluation, Prevention, and Treatment of Chronic Kidney Disease Mineraland Bone Disorder (CKD-MBD)3 Tables and supplementary material6 KDIGO Executive Committee7 Reference keys8 CKD nomenclature9 Conversion factors10 Abbreviations and acronyms11 Notice12 Foreword13 Work Group membership14 Abstract15 Summary of KDIGO CKD-MBD recommendations19 Summary and comparison of 2017 updated and 2009 KDIGO CKD-MBDrecommendations22 Chapter : Diagnosis of CKD-MBD: bone25 Chapter : Treatment of CKD-MBD targeted at lowering high serumphosphate and maintaining serum calcium33 Chapter : Treatment of abnormal PTH levels in CKD-MBD38 Chapter.

2 Treatment of bone with bisphosphonates, other osteoporosismedications, and growth hormone39 Chapter 5: Evaluation and treatment of kidney transplant bone disease41 Methodological approach to the 2017 KDIGO CKD-MBD Guideline update49 Biographic and disclosure 7 | ISSUE 1 | JULY 20172 Kidney International Supplements( 2017 )7, 1 59 TABLES24 Table 1. Utility of KDOQI and KDIGO PTH thresholds for diagnostic decision making42 Table 2. Research questions45 Table 3. Question-specific eligibility criteria46 Table 4. GRADE system for grading quality of evidence for an outcome47 Table 5. Final grade for overall quality of evidence47 Table 6. Balance of benefits and harms47 Table 7. Implications of the strength of a recommendation47 Table 8. Determinants of strength of recommendationSUPPLEMENTARY MATERIALA ppendix A. PubMed search strategyAppendix B. Summary of search and review processTable S1. Summary table of randomized controlled trials examining the treatment of CKD-MBD withbisphosphonates in CKD G3a G5: study characteristicsTable S2.

3 Summary table of randomized controlled trials examining the treatment of CKD-MBD withbisphosphonates in CKD G3a G5: study population characteristicsTable S3. Summary table of randomized controlled trials examining the treatment of CKD-MBD withbisphosphonates in CKD G3a G5: resultsTable S4. Summary table of randomized controlled trials examining the treatment of CKD-MBD withbisphosphonates in CKD G3a G5: qualityTable S5. Evidence matrix of randomized controlled trials examining the treatment of CKD-MBD withbisphosphonates in CKD G3a G5 Table S6. Evidence profile of randomized controlled trials examining the treatment of CKD-MBD withbisphosphonates in CKD G3a G5 Table S7. Summary table of studies evaluating the ability of bone mineral density results to predict fracture orrenal osteodystrophy among patients with CKD G3a G5: study characteristicsTable S8. Summary table of studies evaluating the ability of bone mineral density results to predict fracture orrenal osteodystrophy among patients with CKD G3a G5: study population characteristicsTable S9.

4 Summary table of studies evaluating the ability of bone mineral density results to predict fracture orrenal osteodystrophy among patients with CKD G3a G5: resultsTable S10. Summary table of studies evaluating the ability of bone mineral density results to predict fracture orrenal osteodystrophy among patients with CKD G3a G5: qualityTable S11. Evidence matrix of studies evaluating the ability of bone mineral density results to predict fracture orrenal osteodystrophy among patients with CKD G3a G5 Table S12. Evidence profile of studies evaluating the ability of bone mineral density results to predict fracture orrenal osteodystrophy among patients with CKD G3a G5 Table S13. Summary table of randomized controlled trials examining the treatment of CKD-MBD with varyingdialysate calcium concentration levels in CKD G5D: study characteristicsTable S14. Summary table of randomized controlled trials examining the treatment of CKD-MBD with varyingdialysate calcium concentration levels in CKD G5D: study population characteristicsTable S15.

5 Summary table of randomized controlled trials examining the treatment of CKD-MBD with varyingdialysate calcium concentration levels in CKD G5D: resultsTable S16. Summary table of randomized controlled trials examining the treatment of CKD-MBD with varyingdialysate calcium concentration levels in CKD G5D: qualityTable S17. Evidence matrix of randomized controlled trials examining the treatment of CKD-MBD with varyingdialysate calcium concentration levels in CKD International Supplements( 2017 )7, 1 593 Table S18. Evidence profile of randomized controlled trials examining the treatment of CKD-MBD with varyingdialysate calcium concentration levels in CKD G5 DTable S19. Summary table of randomized controlled trials examining the treatment of CKD-MBD with calcium-containing phosphate binders versus calcium-free phosphate binders: study characteristicsTable S20. Summary table of randomized controlled trials examining the treatment of CKD-MBD with calcium-containing phosphate binders versus calcium-free phosphate binders: study population characteristicsTable S21.

6 Summary table of randomized controlled trials examining the treatment of CKD-MBD with calcium-containing phosphate binders versus calcium-free phosphate binders: resultsTable S22. Summary table of randomized controlled trials examining the treatment of CKD-MBD with calcium-containing phosphate binders versus calcium-free phosphate binders: qualityTable S23. Evidence matrix of randomized controlled trials examining the treatment of CKD-MBD with calcium-containing phosphate binders versus calcium-free phosphate bindersTable S24. Evidence profile of randomized controlled trials examining the treatment of CKD-MBD with calcium-containing phosphate binders versus calcium-free phosphate bindersTable S25. Summary table of randomized controlled trials examining the treatment of CKD-MBD with dietaryphosphate: study characteristicsTable S26. Summary table of randomized controlled trials examining the treatment of CKD-MBD with dietaryphosphate: study population characteristicsTable S27.

7 Summary table of randomized controlled trials examining the treatment of CKD-MBD with dietaryphosphate: resultsTable S28. Summary table of randomized controlled trials examining the treatment of CKD-MBD with dietaryphosphate: qualityTable S29. Evidence matrix of randomized controlled trials examining the treatment of CKD-MBD with dietaryphosphateTable S30. Evidence profile of randomized controlled trials examining the treatment of CKD-MBD with dietaryphosphateTable S31. Summary table of randomized controlled trials examining the treatment of PTH in CKD-MBD: studycharacteristicsTable S32. Summary table of randomized controlled trials examining the treatment of PTH in CKD-MBD: studypopulation characteristicsTable S33. Summary table of randomized controlled trials examining the treatment of PTH in CKD-MBD: resultsTable S34. Summary table of randomized controlled trials examining the treatment of PTH in CKD-MBD: qualityTable S35. Evidence matrix of randomized controlled trials examining the treatment of PTH in CKD-MBDT able S36.

8 Evidence profile of randomized controlled trials examining the treatment of PTH in CKD-MBDT able S37. Summary table of randomized controlled trials examining the treatment of high levels of PTH withcalcitriol or activated vitamin D analogs in CKD G3a G5 not on dialysis: study characteristicsTable S38. Summary table of randomized controlled trials examining the treatment of high levels of PTH withcalcitriol or activated vitamin D analogs in CKD G3a G5 not on dialysis: study population characteristicsTable S39. Summary table of randomized controlled trials examining the treatment of high levels of PTH withcalcitriol or activated vitamin D analogs in CKD G3a G5 not on dialysis: resultsTable S40. Summary table of randomized controlled trials examining the treatment of high levels of PTH withcalcitriol or activated vitamin D analogs in CKD G3a G5 not on dialysis: qualityTable S41. Evidence matrix of randomized controlled trials examining the treatment of high levels of PTH withcalcitriol or activated vitamin D analogs in CKD G3a G5 not on dialysisTable S42.

9 Evidence profile of randomized controlled trials examining the treatment of high levels of PTH withcalcitriol or activated vitamin D analogs in CKD G3a G5 not on dialysisTable S43. Summary table of randomized controlled trials examining the treatment of high levels of PTH in CKDG5D: study characteristicsTable S44. Summary table of randomized controlled trials examining the treatment of high levels of PTH in CKDG5D: study population International Supplements( 2017 )7, 1 59 Table S45. Summary table of randomized controlled trials examining the treatment of high levels of PTH inCKD G5D: resultsTable S46. Summary table of randomized controlled trials examining the treatment of high levels of PTH inCKD G5D: qualityTable S47. Evidence matrix of randomized controlled trials examining the treatment of high levels of PTH inCKD G5 DTable S48. Evidence profile of randomized controlled trials examining the treatment of high levels of PTH inCKD G5 DTable S49.

10 Summary table of studies evaluating different concentrations of serum phosphate or calcium amongpatients with CKD G3a G5 or G5D: study characteristicsTable S50. Summary table of studies evaluating different concentrations of serum phosphate or calcium amongpatients with CKD G3a G5 or G5D: study population characteristicsTable S51. Summary table of studies evaluating different concentrations of serum phosphate among patients withCKD G3a G5 or G5D: resultsTable S52. Summary table of studies evaluating different concentrations of serum calcium among patients withCKD G3a G5 or G5D: resultsTable S53. Summary table of studies evaluating different concentrations of serum phosphate or calcium amongpatients with CKD G3a G5 or G5D: qualityTable S54. Evidence matrix of studies evaluating different concentrations of serum phosphate or calcium amongpatients with CKD G3a G5 or G5 DTable S55. Evidence profile of studies evaluating different concentrations of serum phosphate or calcium amongpatients with CKD G3a G5 or G5 DSupplementary material is linked to the online version of the paper International Supplements( 2017 )7, 1 595 KDIGO EXECUTIVE COMMITTEEG arabed Eknoyan, MDNorbert Lameire, MD, PhDFounding KDIGO Co-chairsBertram L.