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KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD)

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KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) VOLUME 7 | ISSUE 1 | JULY 2017 www.kisupplements.org KKISU_v7_i1_COVER.inddISU_v7_i1_COVER.indd 1 331-05-20171-05-2017 113:23:053:23:05 KDIGO 2017 CLINICAL PRACTICE GUIDELINE UPDATE FOR THE DIAGNOSIS, EVALUATION, PREVENTION, AND TREATMENT OF CHRONIC KIDNEY DISEASE–MINERAL AND BONE DISORDER (CKD-MBD) Kidney International Supplements (2017) 7, 1–59 1 www.kisupplements.org contents VOL 7 | ISSUE 1 | JULY 2017 KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) 3 Tables and supplementary material 6 KDIGO Executive Committee 7 Reference keys 8 CKD nomenclature 9 Conversion factors 10 Abbreviations and acronyms 11 Notice 12 Foreword 13 Work Group membership 14 Abstract 15 Summary of KDIGO CKD-MBD recommendations 19 Summary and comparison of 2017 updated and 2009 KDIGO CKD-MBD recommendations 22 Chapter 3.2: Diagnosis of CKD-MBD: bone 25 Chapter 4.1: Treatment of CKD-MBD targeted at lowering high serum phosphate and maintaining serum calcium 33 Chapter 4.2: Treatment of abnormal PTH levels in CKD-MBD 38 Chapter 4.3: Treatment of bone with bisphosphonates, other osteoporosis medications, and growth hormone 39 Chapter 5: Evaluation and treatment of kidney transplant bone disease 41 Methodological approach to the 2017 KDIGO CKD-MBD guideline update 49 Biographic and disclosure information 55 Acknowledgments 56 References 2 Kidney International Supplements (2017) 7, 1–59 www.kisupplements.org contents TABLES 24 Table 1. Utility of KDOQI and KDIGO PTH thresholds for diagnostic decision making 42 Table 2. Research questions 45 Table 3. Question-specific eligibility criteria 46 Table 4. GRADE system for grading quality of evidence for an outcome 47 Table 5. Final grade for overall quality of evidence 47 Table 6. Balance of benefits and harms 47 Table 7. Implications of the strength of a recommendation 47 Table 8. Determinants of strength of recommendation SUPPLEMENTARY MATERIAL Appendix A. PubMed search strategy Appendix B. Summary of search and review process Table S1. Summary table of randomized controlled trials examining the treatment of CKD-MBD with bisphosphonates in CKD G3a–G5: study characteristics Table S2. Summary table of randomized controlled trials examining the treatment of CKD-MBD with bisphosphonates in CKD G3a–G5: study population characteristics Table S3. Summary table of randomized controlled trials examining the treatment of CKD-MBD with bisphosphonates in CKD G3a–G5: results Table S4. Summary table of randomized controlled trials examining the treatment of CKD-MBD with bisphosphonates in CKD G3a–G5: quality Table S5. Evidence matrix of randomized controlled trials examining the treatment of CKD-MBD with bisphosphonates in CKD G3a–G5 Table S6. Evidence profile of randomized controlled trials examining the treatment of CKD-MBD with bisphosphonates in CKD G3a–G5 Table S7. Summary table of studies evaluating the ability of bone mineral density results to predict fracture or renal osteodystrophy among patients with CKD G3a–G5: study characteristics Table S8. Summary table of studies evaluating the ability of bone mineral density results to predict fracture or renal osteodystrophy among patients with CKD G3a–G5: study population characteristics Table S9. Summary table of studies evaluating the ability of bone mineral density results to predict fracture or renal osteodystrophy among patients with CKD G3a–G5: results Table S10. Summary table of studies evaluating the ability of bone mineral density results to predict fracture or renal osteodystrophy among patients with CKD G3a–G5: quality Table S11. Evidence matrix of studies evaluating the ability of bone mineral density results to predict fracture or renal osteodystrophy among patients with CKD G3a–G5 Table S12. Evidence profile of studies evaluating the ability of bone mineral density results to predict fracture or renal osteodystrophy among patients with CKD G3a–G5 Table S13. Summary table of randomized controlled trials examining the treatment of CKD-MBD with varying dialysate calcium concentration levels in CKD G5D: study characteristics Table S14. Summary table of randomized controlled trials examining the treatment of CKD-MBD with varying dialysate calcium concentration levels in CKD G5D: study population characteristics Table S15. Summary table of randomized controlled trials examining the treatment of CKD-MBD with varying dialysate calcium concentration levels in CKD G5D: results Table S16. Summary table of randomized controlled trials examining the treatment of CKD-MBD with varying dialysate calcium concentration levels in CKD G5D: quality Table S17. Evidence matrix of randomized controlled trials examining the treatment of CKD-MBD with varying dialysate calcium concentration levels in CKD G5D Kidney International Supplements (2017) 7, 1–59 3 contents www.kisupplements.org Table S18. Evidence profile of randomized controlled trials examining the treatment of CKD-MBD with varying dialysate calcium concentration levels in CKD G5D Table S19. Summary table of randomized controlled trials examining the treatment of CKD-MBD with calcium- containing phosphate binders versus calcium-free phosphate binders: study characteristics Table 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 characteristics Table S21. Summary table of randomized controlled trials examining the treatment of CKD-MBD with calcium- containing phosphate binders versus calcium-free phosphate binders: results Table S22. Summary table of randomized controlled trials examining the treatment of CKD-MBD with calcium- containing phosphate binders versus calcium-free phosphate binders: quality Table S23. Evidence matrix of randomized controlled trials examining the treatment of CKD-MBD with calcium- containing phosphate binders versus calcium-free phosphate binders Table S24. Evidence profile of randomized controlled trials examining the treatment of CKD-MBD with calcium- containing phosphate binders versus calcium-free phosphate binders Table S25. Summary table of randomized controlled trials examining the treatment of CKD-MBD with dietary phosphate: study characteristics Table S26. Summary table of randomized controlled trials examining the treatment of CKD-MBD with dietary phosphate: study population characteristics Table S27. Summary table of randomized controlled trials examining the treatment of CKD-MBD with dietary phosphate: results Table S28. Summary table of randomized controlled trials examining the treatment of CKD-MBD with dietary phosphate: quality Table S29. Evidence matrix of randomized controlled trials examining the treatment of CKD-MBD with dietary phosphate Table S30. Evidence profile of randomized controlled trials examining the treatment of CKD-MBD with dietary phosphate Table S31. Summary table of randomized controlled trials examining the treatment of PTH in CKD-MBD: study characteristics Table S32. Summary table of randomized controlled trials examining the treatment of PTH in CKD-MBD: study population characteristics Table S33. Summary table of randomized controlled trials examining the treatment of PTH in CKD-MBD: results Table S34. Summary table of randomized controlled trials examining the treatment of PTH in CKD-MBD: quality Table S35. Evidence matrix of randomized controlled trials examining the treatment of PTH in CKD-MBD Table S36. Evidence profile of randomized controlled trials examining the treatment of PTH in CKD-MBD Table S37. Summary table of randomized controlled trials examining the treatment of high levels of PTH with calcitriol or activated vitamin D analogs in CKD G3a–G5 not on dialysis: study characteristics Table S38. Summary table of randomized controlled trials examining the treatment of high levels of PTH with calcitriol or activated vitamin D analogs in CKD G3a–G5 not on dialysis: study population characteristics Table S39. Summary table of randomized controlled trials examining the treatment of high levels of PTH with calcitriol or activated vitamin D analogs in CKD G3a–G5 not on dialysis: results Table S40. Summary table of randomized controlled trials examining the treatment of high levels of PTH with calcitriol or activated vitamin D analogs in CKD G3a–G5 not on dialysis: quality Table S41. Evidence matrix of randomized controlled trials examining the treatment of high levels of PTH with calcitriol or activated vitamin D analogs in CKD G3a–G5 not on dialysis Table S42. Evidence profile of randomized controlled trials examining the treatment of high levels of PTH with calcitriol or activated vitamin D analogs in CKD G3a–G5 not on dialysis Table S43. Summary table of randomized controlled trials examining the treatment of high levels of PTH in CKD G5D: study characteristics Table S44. Summary table of randomized controlled trials examining the treatment of high levels of PTH in CKD G5D: study population characteristics 4 Kidney International Supplements (2017) 7, 1–59 www.kisupplements.org contents Table S45. Summary table of randomized controlled trials examining the treatment of high levels of PTH in CKD G5D: results Table S46. Summary table of randomized controlled trials examining the treatment
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