Hosam Mohamed-
a
Which is due to consistently high PTH levels? (high bone turnover)
a) Ostetitis Fibrosa Cystica
b) Adynamic bone disease
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b
Which is due to oversuppressed PTH levels? (low bone turnover)
a) Ostetitis Fibrosa Cystica
b) Adynamic bone disease
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vitamin d, iPTH, phsophorus, calcium
Which lab tests do we use for CKD-MBD? (4)
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8.5-10.2 mg/dL
What is the normal range for Corrected Ca?
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2.7-4.6 mg/dL
What is the normal range for phosphate?
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14-64 pg/ml
What is the normal range for iPTH?
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> 20 ng/ml
What is the normal range for 25(OH)D?
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restriction of dietary phosphorus intake; < 800-1000 mg/day
What is the nonpharmalogical recommendations for CKD-MBD?
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CKD + persistent hyperphosphatemia
What is the indication for Phosphate binders?
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must administer with meals to be effective; titrated every 2-3 weeks until PO4 levels are normalized ; take other meds 1-2 hrs before or 3 hrs after
What is the counseling for Phosphate Binders? (3)
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oral calcium binders
What is the 1st line option in patients WITHOUT hypercalcemia?
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1500 mg
What is the max dose of elemental calcium per day?
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200 mg
What is the elemental calcium for Calcium Carbonate?
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169
What is the elemental calcium for Calcium Acetate?
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resin binders
What is the first-line option for patients WITH hypercalcemia or risk of
calcifications?
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ferric citrate, sevelamers
Which binders must be taken whole? (2)
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d
Which must be chewed?
a) calcium carbonate
b) Sevelamer Carbonate
c) Ferric citrate
d) Sucroferric oxyhydroxide
e) Sevelamer hydrochloride
f) calcium acetate
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potential for systemic/GI accumulation if taken whole
What are the potential risks associated with Lananthum?
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aluminum hydroxide
What is the last line option due to toxicity?
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< 4 weeks
How long can a patient use Aluminum Hydroxide?
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a
Which has drug interactions with PPIs & H2 blockers?
a) calcium carbonate
b) Sevelamer Carbonate
c) Ferric citrate
d) Sucroferric oxyhydroxide
e) Sevelamer hydrochloride
f) calcium acetate
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serum calcium, risk for calcifications, iron status, pill burden, cost, formulation
What are the considerations when choosing a phosphate binder? (6)
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<30 ng/mL
Which patients are indicated for Vitamin D supplementation?
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CKD + hemodialysis
Which patients should NOT be using Inactive vitamin D?
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inactive vitamin D
Which form of vitamin D should be used in patients NOT on hemodialysis?
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50,000 IU weekly x 6-12 weeks
What is the initial treatment dose? (Inactive Vitamin D)
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800-2000 IU daily
What is the maintenance dose for Inactive Vitamin D?
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25(OH)D, calcium, phosphorus, PTH
What monitoring must be done for patients on vitamin D supplementation? (4)
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sevelamer carbonate, sevelamer hydrochloride
What are the Resin binders? (2)
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ferric citrate, sucroferric oxyhydroxide
What are the iron based binders? (2)
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c
Which can helpful in patients with iron deficiency?
a) calcium carbonate
b) Sevelamer Carbonate
c) Ferric citrate
d) Sucroferric oxyhydroxide
e) Sevelamer hydrochloride
f) calcium acetate
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CKD stage: 3-4
What is the indication for Calcifediol?
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CKD stage 4-5 + persistently high PTH + hemodialysis
What is the indication for Vitamin D analogs?
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Hypercalcemia/hyperphosphatemia; nutritional vitamin D supplements
_________ is a bigger concern with Vitamin D analogs than __________.
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ESRD + hemodialysis
What is the indication for Calcimimetics?
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serum calcium < 8.4
When do we NOT initiate a Calcimimetic?
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CYP3A4; CYP2D6
Cinacalcet is metabolized by ________ and is a potent inhibitor of ________.
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vitamin D, calcium (early CKD)
Which labs will decrease? (2)
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phosphorus, calcium (late CKD)
Which labs will increase? (2)
