Rational use of vitamin D analogues and calcium carbonate in chronic kidney disease-mineral bone disorder (CKD-MBD): a Sri Lankan perspective

The empirical use of vitamin D analogues and calcium carbonate remains common among patients with chronic kidney disease in Sri Lanka. These agents are often prescribed without biochemical evidence of secondary hyperpara-thyroidism or hyperphosphataemia, which can cause hypercalcaemia, vascular calcification, adynamic bone disease and increased cardio-vascular morbidity and mortality. This article summarises a practical guideline for managing chronic kidney disease-mineral bone disorder in Sri Lanka, based on the Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Guideline, and highlights a rational, step-by-step approach that uses monitoring of alkaline phosphatase, calcium, and phosphate, rather than unavailable parathyroid hormone assays.