Canadian Society of Nephrology Commentary on the Kidney Disease Improving Global Outcomes 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder

Author:

Holden Rachel M.1ORCID,Mustafa Reem A.23,Alexander R. Todd4,Battistella Marisa5,Bevilacqua Micheli U.6,Knoll Greg7,Mac-Way Fabrice8,Reslerova Martina9,Wald Ron10ORCID,Acott Philip D.11,Feltmate Patrick12,Grill Allan13,Jindal Kailash K.14,Karsanji Meena15,Kiberd Bryce A.16,Mahdavi Sara1718,McCarron Kailee19,Molnar Amber O.20ORCID,Pinsk Maury21,Rodd Celia22,Soroka Steven D.23ORCID,Vinson Amanda J.24,Zimmerman Deborah25,Clase Catherine M.26ORCID

Affiliation:

1. Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada

2. Division of Nephrology and Hypertension, Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, USA

3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

4. Department of Pediatrics and Physiology, University of Alberta, Edmonton, Canada

5. University Health Network, Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada

6. Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada

7. Division of Nephrology, The Ottawa Hospital, ON, Canada

8. Division of Nephrology, CHU de Québec, Hôtel-Dieu de Québec Hospital, Université Laval, Québec City, QC, Canada

9. Nephrology Section, St. Boniface General Hospital, University of Manitoba, Winnipeg, Canada

10. Division of Nephrology, St. Michael’s Hospital, University of Toronto, ON, Canada

11. Division of Nephrology, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada

12. Department of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada

13. Department of Family & Community Medicine, University of Toronto, ON, Canada

14. Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada

15. Professional Practice, Vancouver Coastal Health, Richmond, BC, Canada

16. Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada

17. Department of Nutritional Sciences, University of Toronto, ON, Canada

18. Department of Nephrology, Scarborough Health Network, ON, Canada

19. Nova Scotia Renal Program, Nova Scotia Health Authority, Halifax, Canada

20. Division of Nephrology, McMaster University, Hamilton, ON, Canada

21. Division of Nephrology, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada

22. Division of Diabetes & Endocrinology, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada

23. Division of Nephrology, Department of Medicine, Dalhousie University, NSHA Renal Program and Pharmacy Services, Halifax, NS, Canada

24. Division of Nephrology, Dalhousie University, Halifax, NS, Canada

25. Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada

26. Division of Nephrology, Department of Medicine, Department of Health Research, Evidence and Impact, McMaster University, Hamilton, ON, Canada

Abstract

Purpose of review: (1) To provide commentary on the 2017 update to the Kidney Disease Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD); (2) to apply the evidence-based guideline update for implementation within the Canadian health care system; (3) to provide comment on the care of children with chronic kidney disease (CKD); and (4) to identify research priorities for Canadian patients. Sources of information: The KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD. Methods: The commentary committee co-chairs selected potential members based on their knowledge of the Canadian kidney community, aiming for wide representation from relevant disciplines, academic and community centers, and different geographical regions. Key findings: We agreed with many of the recommendations in the clinical practice guideline on the diagnosis, evaluation, prevention, and treatment of CKD-MBD. However, based on the uncommon occurrence of abnormalities in calcium and phosphate and the low likelihood of severe abnormalities in parathyroid hormone (PTH), we recommend against screening and monitoring levels of calcium, phosphate, PTH, and alkaline phosphatase in adults with CKD G3. We suggest and recommend monitoring these parameters in adults with CKD G4 and G5, respectively. In children, we agree that monitoring for CKD-MBD should begin in CKD G2, but we suggest measuring ionized calcium, rather than total calcium or calcium adjusted for albumin. With regard to vitamin D, we suggest against routine screening for vitamin D deficiency in adults with CKD G3-G5 and G1T-G5T and suggest following population health recommendations for adequate vitamin D intake. We recommend that the measurement and management of bone mineral density (BMD) be according to general population guidelines in CKD G3 and G3T, but we suggest against routine BMD testing in CKD G4-G5, CKD G4T-5T, and in children with CKD. Based on insufficient data, we also recommend against routine bone biopsy in clinical practice for adults with CKD or CKD-T, or in children with CKD, although we consider it an important research tool. Limitations: The committee relied on the evidence summaries produced by KDIGO. The CSN committee did not replicate or update the systematic reviews.

Funder

opko health

sanofi

Patient-Centered Outcomes Research Institute

american society of hematology

the American College of Rheumatology

Otsuka Canada Pharmaceutical Inc.

Janssen

amgen

Ontario Ministry of Health

NGX

health canada

Nutrigenomix Inc,

Central East Local Health Integration Network

Ontario Renal Network

sanofi genzyme

boehringer ingelheim

Baxter

Publisher

SAGE Publications

Subject

Nephrology

Reference126 articles.

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