Target PTH Range for CKD Stages

PTH Targets by CKD Stage

For patients with CKD G5D (on dialysis), intact PTH levels should be maintained in the range of approximately 2 to 9 times the upper normal limit for the assay 1, 2, 3
For patients with CKD G3a-G5 not on dialysis, the optimal PTH level is not definitively established 1, 2
Patients with progressively rising or persistently elevated PTH above the upper normal limit should be evaluated for modifiable factors including hyperphosphatemia 3, hypocalcemia 3, high phosphate intake 2, and vitamin D deficiency 3

Monitoring frequency should be based on baseline PTH level and CKD progression 1
More frequent monitoring is recommended if PTH is rising or persistently elevated 1

Treatment decisions should be based on trends in PTH levels rather than single measurements 1
When PTH levels are outside the target range, consider calcimimetics, calcitriol, or vitamin D analogs, or combinations for elevated PTH 1
Parathyroidectomy should be considered in patients with severe hyperparathyroidism who fail to respond to medical therapy 1

Treatment of CKD-MBD should be based on serial assessments of phosphate, calcium, and PTH levels considered together, not just PTH in isolation 2
Avoid hypercalcemia in adults with CKD G3a-G5D 1
Maintain serum phosphorus toward the normal range 2
Consider the presence of vascular or valvular calcification in risk assessment and management 2