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However, based on the\n            uncommon occurrence of abnormalities in calcium and phosphate and the low likelihood of\n            severe abnormalities in parathyroid hormone (PTH), we recommend against screening and\n            monitoring levels of calcium, phosphate, PTH, and alkaline phosphatase in adults with\n            CKD G3. We suggest and recommend monitoring these parameters in adults with CKD G4 and\n            G5, respectively. In children, we agree that monitoring for CKD-MBD should begin in CKD\n            G2, but we suggest measuring ionized calcium, rather than total calcium or calcium\n            adjusted for albumin. With regard to vitamin D, we suggest against routine screening for\n            vitamin D deficiency in adults with CKD G3-G5 and G1T-G5T and suggest following\n            population health recommendations for adequate vitamin D intake. We recommend that the\n            measurement and management of bone mineral density (BMD) be according to general\n            population guidelines in CKD G3 and G3T, but we suggest against routine BMD testing in\n            CKD G4-G5, CKD G4T-5T, and in children with CKD. Based on insufficient data, we also\n            recommend against routine bone biopsy in clinical practice for adults with CKD or CKD-T,\n            or in children with CKD, although we consider it an important research tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>The committee relied on the evidence summaries produced by KDIGO. The CSN committee did\n            not replicate or update the systematic reviews.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2054358120944271","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T07:17:19Z","timestamp":1596525439000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Canadian Society of Nephrology Commentary on the Kidney Disease Improving          Global Outcomes 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation,          Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone          Disorder"],"prefix":"10.1177","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6431-3127","authenticated-orcid":false,"given":"Rachel M.","family":"Holden","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of\r        Medicine, Queen\u2019s University, Kingston, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reem A.","family":"Mustafa","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension,\r        Department of Internal Medicine, The University of Kansas Medical Center, Kansas City,\r        USA"},{"name":"Department of Health Research Methods,\r        Evidence, and Impact, McMaster University, Hamilton, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Todd","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Physiology,\r        University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa","family":"Battistella","sequence":"additional","affiliation":[{"name":"University Health Network, Leslie Dan Faculty\r        of Pharmacy, University of Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micheli U.","family":"Bevilacqua","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of\r        Medicine, The University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Knoll","sequence":"additional","affiliation":[{"name":"Division of Nephrology, The Ottawa Hospital,\r        ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice","family":"Mac-Way","sequence":"additional","affiliation":[{"name":"Division of Nephrology, CHU de Qu\u00e9bec,\r        H\u00f4tel-Dieu de Qu\u00e9bec Hospital, Universit\u00e9 Laval, Qu\u00e9bec City, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Reslerova","sequence":"additional","affiliation":[{"name":"Nephrology Section, St. Boniface General\r        Hospital, University of Manitoba, Winnipeg, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4411-8169","authenticated-orcid":false,"given":"Ron","family":"Wald","sequence":"additional","affiliation":[{"name":"Division of Nephrology, St. Michael\u2019s\r        Hospital, University of Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip D.","family":"Acott","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of\r        Pediatrics, Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Feltmate","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Dalhousie\r        University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Grill","sequence":"additional","affiliation":[{"name":"Department of Family &amp; 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