1. Prospective studies evaluating BMD testing in adults with CKD represent a substantial advance since the original guideline from 2009, making a reasonable case for BMD testing if the results will impact future treatment.|
2. It is important to emphasize the interdependency of serum calcium, phosphate, and PTH for clinical therapeutic decision-making.
3. Phosphate-lowering therapies may only be indicated in the case of “progressive or persistent hyperphosphatemia”.
4. New evidence suggests that excess exposure to exogenous calcium in adults may be harmful in all severities of CKD, regardless of other risk markers.
5. It is reasonable to limit dietary phosphate intake, when considering all sources of dietary phosphate (including “hidden” sources).
6. The PRIMO* and OPERA** studies failed to demonstrate improvements in clinically relevant outcomes but did demonstrate increased risk of hypercalcemia. Accordingly, routine use of calcitriol or its analogs in CKD G3a-G5 is no longer recommended.
7. No consensus was reached to recommend cinacalcet as first-line therapy for lowering PTH in all patients with SHPT and CKD G5D.