PATHOPHYSIOLOGY OF CKD-MBD
Starts with decreased renal elimination of...
Hyperphosphatemia associated with increased risk of...
-Can sig impact patient quality of life
CV events, mortality
Serum : Normal Range
NON-PHARM THERAPY OF CKD-MBD
What is the 1st-line therapy?
Dietary phosphorus restriction
�Also referred to as "binders"
�Used in conjunction with dietary phosphorus restriction for hyperphosphatemia
�Bind to dietary phosphorus to form insoluble complex --> passed in feces
What is the first line therapy for high PTH?
-Suppresses PTH synthesis by increasing GI Ca2+ and PO4 absorption
Vitamin D Analogs
�Last line for PTH suppression
�Binds to calcium-sensing receptors (CaSR) to increase sensitivity to Ca2+ --> "mimics" calcium
�Generally not needed until ESKD
Adverse effects of Calcimimetics:
Drug-Drug Interactions of calcimimetics?
Should not be started in patients with...
Monitoring of Calcimimetics require close monitoring of calcium, PTH:
1 week after starting
�Decreases serum phosphorus by binding dietary phosphorus (and preventing it from being absorbed)
�Must be taken...
Adverse effects of Phosphate-Binding agents:
Hypercalcemia (calcium-based binders)
How should oral meds be given to prevent Drug-Drug Interactions?
Give 2 hours BEFORE binder
Give 4 hours AFTER binder
Iron-based phosphate binding agents can cause....
darkening of stools
Vitamin D analogs:
hypercalcemia, hyperphosphatemia, over-suppression of PTH
Absorption can be decreased if given with cholestyramine
Which Vitamin D supplement (PO) is preferred in non-dialysis dependent CKD (Stage 3 & 4)
Which Vitamin D supplement (IV) is used in Stage 5 CKD?
-How are IV formulations dosed?