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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -9 مورد

Surveillance and monitoring protocols for CKD-MBD in children

Surveillance and monitoring protocols for CKD-MBD in children
Stage of CKD GFR
(mL/min/1.73 m2)		 Calcium and phosphate PTH ALP 25-OHD Target serum PTH
(pg/mL)
Kidney Disease Outcomes Quality Initiative: Minimum intervals for testing[1]
Stage G2 60 to 89 12 months 12 months 12 months 12 months* 35 to 70
Stage G3 30 to 59 6 months 6 months 6 months 12 months* 35 to 70
Stage G4 15 to 29 3 months 3 months 3 months 12 months* 70 to 110
Stage G5 <15, or on dialysis 1 month 3 months 3 months   200 to 300
Kidney Disease: Improving Global Outcomes (KDIGO)[2]
Stage G2 60 to 89 NS NS NS NSΔ NS
Stage G3 30 to 59 6 to 12 months Based on baseline level and CKD progression NS NSΔ NS
Stage G4 15 to 29 3 to 6 months 6 to 12 months 12 months◊ NSΔ NS
Stage G5 <15, or on dialysis 1 to 3 months 3 to 6 months 12 months◊ NSΔ If on dialysis: 2 to 9 times ULN
European Society for Paediatric Nephrology (ESPN) and others[3,4]: Children ≥2 years§
Stage G2 60 to 89 6 months 12 months 12 months 12 months NS
Stage G3 30 to 59 6 months 6 months 6 months 6 months¥ NS
Stage G4 15 to 29 3 months 3 months 3 months 3 to 12 months¥ NS
Stage G5 <15, or on dialysis Monthly 1 to 3 months 1 to 3 months 3 to 12 months¥ NS
This table summarizes guidance on laboratory testing for children with CKD. The KDIGO guideline suggests measurement of bone density for children with evidence of CKD-BMD if the results will alter treatment decisions[2].

25-OHD: 25-hydroxyvitamin D; ALP: alkaline phosphatase; CKD: chronic kidney disease; ESPN: European Society for Paediatric Nephrology; GFR: glomerular filtration rate; KDIGO: Kidney Disease: Improving Global Outcomes; MBD: metabolic bone disorder; NS: not specified; PTH: parathyroid hormone; ULN: upper limit of normal.

* If vitamin D therapy is initiated, we measure 25-OHD every 3 months until normal, then every 6 to 12 months.

¶ KDIGO recommends initiating screening for children in stage G2 but does not specify the frequency of testing for this group[2].

Δ KDIGO does not specify an interval for measuring 25-OHD but recommends supplementation if vitamin D deficiency is identified[2].

◊ KDIGO recommends measuring ALP at least every 12 months and more frequently if PTH is elevated[2].

§ For patients age 6 months to <2 years, ESPN suggests more frequent monitoring[4]:
  • Mild CKD – Measure calcium, phosphate, PTH, and ALP every 3 to 6 months and 25-OHD every 6 months. Target serum PTH in normal range.
  • Moderate CKD – Measure calcium, phosphate, PTH, and ALP every 1 to 3 months and 25-OHD every 3 to 6 months. Target serum PTH is 1 to 2 times ULN.
  • Severe CKD/dialysis – Measure calcium, phosphate, PTH, and ALP every 1 to 4 weeks and 25-OHD every 3 months. Target serum PTH is 2 to 3 times ULN.

PTH should not be assessed before 4 weeks of life.

¥ If vitamin D supplements are initiated, check levels after 3 months. If the serum 25-OHD level is normal, levels should be measured every 6 months. If low, replacement therapy should be provided with a repeat 25-OHD in 3 months[3].
References:
  1. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis 2005; 46:S1.
  2. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2017; 7:1.
  3. Bakkaloglu SA, Bacchetta J, Lalayiannis AD, et al. Bone evaluation in paediatric chronic kidney disease: clinical practice points from the European Society for Paediatric Nephrology CKD-MBD and Dialysis working groups and CKD-MBD working group of the ERA-EDTA. Nephrol Dial Transplant 2021; 36:413.
  4. Bacchetta J, Schmitt CP, Bakkaloglu SA, et al. Diagnosis and management of mineral and bone disorders in infants with CKD: clinical practice points from the ESPN CKD-MBD and Dialysis working groups and the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2023; 38:3163.
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