PTH and chronic kidney disease: However, for stage 3–5D CKD, KDIGO guidelines “recommend restricting the dose of calcium-based phosphate binders ... in the presence of persistent or recurrent hypercalcemia” and “suggest restricting the dose of calcium-based phosphate binders in the presence of arterial calcification and/or adynamic bone disease and/or if serum PTH levels are persistently low” (guideline 4.1.5) [28].