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Testing Patterns for CKD-MBD Abnormalities in a Sample US Population
James B Wetmore1,2, Yuanyuan Ji1, Akhtar Ashfaq3
1Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.
Insights
Testing and retesting for chronic kidney disease mineral bone disorder (CKD-MBD) appear suboptimal. Few patients with CKD stages 4 and 5 received recommended parathyroid hormone (PTH) and 25D testing, and posttreatment retesting rates were low.
Area of Science:
- Nephrology
- Endocrinology
- Public Health
Background:
- Chronic kidney disease mineral bone disorder (CKD-MBD) management guidelines exist but their adherence is not well-documented.
- Large-scale electronic health record data offers a unique opportunity to study CKD-MBD testing and treatment patterns.
Purpose of the Study:
- To evaluate the concordance with CKD-MBD management guidelines.
- To analyze testing, treatment, and retesting patterns in CKD patients.
- To identify predictors of posttreatment retesting.
Main Methods:
- Utilized 2010-2019 electronic health record data from over 50 million patients.
- Created cohorts of CKD stages 3, 4, and 5 patients based on diagnosis codes and eGFR.
- Assessed CKD-MBD test ordering, drug prescribing, and retesting rates using multivariable Cox regression.
Main Results:
- Only 46% of stage 4 and 41% of stage 5 CKD patients received PTH testing.
- Posttreatment retesting for PTH and 25D within one year was suboptimal across all CKD stages.
- Pretreatment PTH and 25D levels did not consistently predict likelihood of retesting.
Conclusions:
- Testing frequency for CKD-MBD abnormalities is suboptimal.
- Posttreatment retesting rates for CKD-MBD are insufficient.
- Current CKD-MBD management may not align with established guidelines.
Introduction:
Patterns of testing, treatment, and retesting following treatment for disorders of chronic kidney disease mineral bone disorder (CKD-MBD) have not been explored using a large electronic database.
Methods:
To determine concordance with CKD-MBD management guidelines, we used 2010 to 2019 data from an electronic health record (>50 million patients) to create cohorts of incident CKD stage 3, 4, and 5 patients using diagnosis codes and estimated glomerular filtration rates. The CKD-MBD test ordering and relevant drug prescribing were assessed during follow-up. We estimated cumulative incidence of posttreatment retesting (death as competing risk). We used multivariable Cox regression to examine baseline characteristics and pretreatment test results as predictors of retesting.
Results:
For 215,553 stage 3, 43,576 stage 4, and 11,407 stage 5 CKD patients, the mean follow-up was 2.3, 1.7, and 0.6 years, respectively. Only 46% of stage 4 and 41% of stage 5 patients underwent parathyroid hormone (PTH) testing, 74% and 73% had phosphorus testing, and 38% and 25% had 25D testing. By 1 year after vitamin D sterol treatment, only 50%, 53%, and 60% of stage 3, 4, and 5 patients had been retested for PTH. By 1 year after treatment with ergocalciferol or cholecalciferol, only 46%, 49%, and 55% had 25D reassessed. Pretreatment levels of PTH and 25D were not associated in a graded fashion with likelihood of retesting after treatment. Rates of retesting were not highest for patients with the highest and lowest pre-treatment PTH and 25D levels, respectively.
Conclusion:
Frequency of testing for CKD-MBD abnormalities and posttreatment retesting appears to be suboptimal.
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