Do you recommend using vitamin D analogs for patients with CKD and a high PTH but a normal 25-hydroxy vitamin D level?

The answer is that it depends on how high the PTH level is. KDIGO guidelines originally recommended targeting PTH between 65 and 130 for patients with non-dialysis CKD by using nutritional vitamin D if the 25-OH vitamin D level is low and using active vitamin D if the 25-OH vitamin D level is normal if the PTH is >130. In the most recent version of the KDIGO mineral and bone disease guidelines, KDIGO cautions providers to weigh the benefit of lowering elevated PTH levels (which may improve bone ...

The real answer to the question is I don't know. However in the meantime, I do treat PTH over 100 in patients with ckd stage 3. First I would treat 25 vitamin D deficiency if present. If patient does not respond, then I would give 1,25 vitamin D (calcitriol) unless the serum calcium is elevated.

Yes, I do recommend using vitamin D analogs such as calcitriol e.g. starting at 0.25 mcg every other day for patients with CKD not on dialysis and a high PTH (>70 pg/ml) or on dialysis (>130 pg/ml) even if there is normal 25-hydroxy vitamin D level (>30) or even of patient is on adequate doses of D3 cholecalciferol (800 to 5,000 IU/day) or D2 ergocalciferol (50,000 units q week to q month).