What are the recommended screening protocols for CKD-MBD in patients with stage 3 or higher chronic kidney disease?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Recommended screening protocols for CKD-MBD in patients with stage 3 or higher CKD:

  • Do not routinely measure serum calcium, phosphate, parathyroid hormone (PTH), and vitamin D levels in adults with a GFR of 30 ml/min/1.73 m or more (CKD stages G1, G2, or G3) .
  • Measure serum calcium, phosphate, and parathyroid hormone concentrations in adults with a GFR of less than 30 ml/min/1.73 m (CKD stages G4 or G5) .
  • Determine the frequency of subsequent testing based on the measured values and clinical circumstances; seek specialist opinion if uncertain .
  • Do not routinely offer vitamin D supplementation to manage or prevent CKD-MBD, but offer colecalciferol or ergocalciferol to treat vitamin D deficiency in people with CKD and vitamin D deficiency .
  • If vitamin D deficiency is corrected and CKD-MBD symptoms persist, offer alfacalcidol or calcitriol to people with GFR less than 30 ml/min/1.73 m (G4 or G5) and monitor serum calcium and phosphate concentrations during treatment .

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