Actually the CKD guidance makes little sense. I
wonder whether anyone tried to model
the flux of patients through the system.
The next stage of the guidance after PTH states
"If 25-OH D is low (<80nmol/l, 30 micrograms/l),
prescribe ergocalciferol or colecalciferol
800u/day in a preparation that contains calcium
lactate or carbonate (not phosphate).
Colecalciferol 10,000u by IM injection once
monthly is an alternative. Recheck PTH in 3
months. If now <70, continue; if still high,
refer"
Given that more that 70% of the general UK
population will have 25(D) < 80nmol/L (more in "ill"
people") they may as well have shortcut the entire
process by putting everyone on Vitamin D. At the
moment we have an extremely costly process that
alters decisions in very few.
In any event, in someone with 25(OH)D of say
25nmol/L (an average renal patient) a dose of
800U/day won't push 25(OH)D above their magic
threshold of 80nmol/L in most people, so that bit
of logic also escapes me. The type of therapy
should have been tailored to the findings.
Aubrey
MAJ> Dear All,
MAJ>
MAJ> CKD guidance recommends that in patients
MAJ> with eGFR of 30 - 59 mL/min/1.73m2, a PTH
MAJ> should be measured and if it is > 70 ng/L (??
MAJ> > 7.7 pmol/L), then vitamin D should be checked.
MAJ>
MAJ> Are you accepting PTH & vitamin D requests
MAJ> on these patients even if serum calcium,
MAJ> phosphate and ALP are well within normal?
MAJ>
MAJ> What is the strength of evidence, if any,
MAJ> of the above recommendation? Are there any
MAJ> oucome data of vitamin D therapy benefit in
MAJ> patients with stage 3 CKD?
MAJ>
MAJ> Thanks for any feedback.
MAJ>
MAJ> Mohammad
MAJ>
MAJ>
MAJ>
MAJ>
MAJ> Dr. M A Al-Jubouri
MAJ> Consultant Chemical Pathologist
MAJ> Yahoo! Answers - Get better answers from
MAJ> someone who knows. Try it now. ------ACB
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Regards
Aubrey Blumsohn
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