Laboratory testing for biochemical markers of mineral bone disease (MBD) in patients with moderate-to-severe chronic kidney disease (CKD) may be suboptimal relative to guideline recommendations, investigators reported in the American Journal of Nephrology.

These markers include parathyroid hormone (PTH), phosphorus, 25-hydroxyvitamin D [25(OH)D], calcium, and alkaline phosphatase (ALP).

Nicholas S. Roetker, MD, and collaborators at the Hennepin Healthcare Research Institute in Minneapolis, Minnesota, looked at administrative claims records from a 20% sample of Medicare beneficiaries with Parts A, B, and D coverage during the period 2007 to 2015. They identified patients with nondialysis stage 3, 4, or 5 CKD and compared the frequency of testing for PTH, 25(OH)D, phosphorus calcium, and ALP with what is recommended in the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.

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Dr Roetker’s team divided the patients into 3 cohorts (640,946 patients with stage 3 CKD, 136,278 patients with stage 4 CKD, and 22,076 patients with stage 5 CKD). The 3 cohorts were slightly more female than male (52.9% vs 50.2%). The mean age ranged from 74.4 to 78.0 years. The cohorts had mean follow-up durations of 2.5, 1.3, and 0.7 years, respectively.

Testing frequency was lower for PTH (35.2% to 48.2%), phosphorus (46.6 to 62.0%), and 25(OH)D (29.3% to 46.7%) compared with guideline recommendations. Testing rates were slightly higher for calcium (88.1% to 95.4%) and ALP (63.5% to 88.1%).

Older age, a greater number of comorbid conditions, and lack of prior nephrology care were associated with a lower likelihood of testing.

“Competing priorities, such as management of comorbid disease and preparation for renal replacement therapy, may distract from CKD-MBD monitoring,” the authors concluded.


Roetker NS, Peng Y, Ashfaq A, et al. Adherence to Kidney Disease: Improving Global Outcomes Mineral and Bone Guidelines for Monitoring Biochemical Parameters. Am J Nephrol. 2019;49:225-232.