Recommendation ID
CG182/5
Question
In people with hyperparathyroidism secondary to CKD, does treatment with vitamin D or vitamin D analogues improve patient-related outcomes?
Any explanatory notes
(if applicable)
Why this is important: Changes in bone and mineral metabolism and alterations in calcium and phosphate homeostasis occur early in the course of CKD and progress as kidney function declines. The prevalence of hyperparathyroidism increases from 5.5% in people with a GFR over 90 ml/min/1.73 m2 to 23%, 44% and 73% in people with a GFR of 45–59, 30–44 and under 30 ml/min/1.73 m2 respectively. 25-Hydroxyvitamin D deficiency is twice as prevalent in people with a GFR under 30 ml/min/ 1.73 m2 compared with those with a normal GFR. Decreased bone mass and changes in bone microarchitecture occur and progress early in CKD increasing the risk of bone fracture. Replacing vitamin D in people with CKD is known to reduce hyperparathyroidism but there is little data to suggest any benefit on clinical outcomes (including CKD progression measured by change in eGFR, all-cause mortality, cardiovascular mortality, cardiovascular events, fractures and hypercalcaemia). Potential benefits of vitamin D therapy in people with CKD include increased bone mineral density and muscle strength, reduced risk of falls and fractures, and reduction in hyperparathyroidism. Potential adverse effects are hypercalcaemia and extraskeletal (vascular) calcification, and increased cardiovascular risk.

Source guidance details

Comes from guidance
Chronic kidney disease in adults: assessment and management
Number
CG182
Date issued
July 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 07/10/2014