Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
No recommendations possible based on Level I or II evidence
Suggestions for Clinical Care
(Suggestions are based on Level III and IV evidence)
- Children with chronic kidney disease (CKD) or end-stage kidney disease (ESKD) should be monitored regularly for renal osteodystrophy, and treated with vitamin D if this develops.
- Calcitriol or synthetic analogues are suitable for use in children. Calcitriol liquid is available in Australia through the Small Activities Scheme (SAS), being imported from New Zealand. Alternatively, the fluid can be aspirated from capsules. The parathyroid hormone (PTH) level should be maintained under a level twice the upper limit of the normal range.
Although Level I or II evidence is not available, published clinical studies do not support the notion that correcting biochemically evident secondary hyperparathyroidism improves linear growth in children with CKD.
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test