chronic kidney disease part 2

increase, decrease, increase

decrease GFR ______ PO4, which _____ serum Ca, and ______ PTH

A. increase, decrease, decrease
B. increase, decrease, increase
C. decrease, increase, decrease
D. increase, increase, decrease

decrease, decrease, increase

decrease production of vitamin D3 _____ GI absorption of Ca and PO4, which _____ Ca and ______ PTH

A. increase, increase, increase
B. decrease, increase, decrease
C. decrease, decrease, increase
D. increase, increase, decrease

osteomalacia

decrease production of vitamin D3 causes _____

increase Calcium mobilization from bone

renal osteodystrophy

- increase calcium renal absorption
- decrease PO4 tubular reabsorption
- osteomalacia (decrease production of Vitamin D3)

are the causes of _____

< 9.5 mg/dL

Ca goal for patients with CKD

alkaline phosphatase

helpful for bone turnover

false

true or false

dialysis is an effective approach to remove PO4

phosphate binders

first line for CKD induced bone disorder treatment

phosphate binders

- calcium acetate
- calcium carbonate
- sevelamer carboneate
- sevelamer hydrochloride
- aluminum hydroxide
- lanthanum carbonate

calcium acetate

- phoslo
- 667 mg TID

calcium carbonate

- Tums, Os-Cal, Caltrate
- 500 mg TID

Sevelamer carbonate

- renvela
- 800 mg TID

sevelamer hydrochloride

- renagel
- 800 mg TID

Aluminum hydroxide

- AlternaGel
- 300-600 mg TID

Lanthanum carbonate

- Fosrenol
- 500 mg TID

calcium acetate

- first line agent for treating high Phosphate
- only used if corrected Ca < 10.5 mg/dL

sevelamer hydrochloride

- use when Ca is high
- preferred in hypercalcemia, calcifications, dynamic bone disease

sevelamer hydrogchloride

which one is more preferred?

A. sevelamer carbonate
B. sevelamer hydrochloride

aluminum hydroxide

- restrict to acute situations
- can induce risk of intoxication

sevelamer

which of the following has more GI side effects?

A. sevelamer products
B. calcium products
C. aluminum binders

aluminum hydroxide

- CNS toxicity
- anemia

are the side effects of

ergocalciferol

50,000 units PO weekly

cholecalciferol

6000 units daily

nutritional vitamin D

- ergocalciferol
- cholecalciferol

calcitrol (rocaltrol)

0.25 mcg daily PO

calcitriol (calcijex)

1-2 mcg TIW IV

- calcitriol
- paricalcitol

vitamin D agents that are reserved for dialysis patients with CKD

< 30 ng/mL

therapy must be initiated when vitamin D level is ______ in patients with CKD and bone disease

ergocalciferol

- 50,000 units weekly for 12 weeks
- then weekly/monthly for 6 months

calcitriol

which of the following is more effective in increase Ca

A. calcitriol
B. paricalcitol

cinacalet hydrochloride

- Sensipar
- calcimimetics
- decrease calcium

30 mg PO daily

Sensipar dosing

sensipar

- increase sensitivity of Calcium-sensing receptor on parathyroid gland
- decrease PTH
- decrease serum Ca
- used in combination with Vitaminn D therapy
- second treatment to decrease PO4

once week after initiation then monthly

how to monitor Ca after initiating or adjusting Sensipar?

1-4 weeks after initiation

how to monitor PTH after initiating or adjusting Sensipar?

sevelamer

- used when corrected Ca > 10.5 mg/dL
- phosphate binder
- decrease PO4

calcium binders

- used when corrected Ca < 10.5 mg/dL
- phosphate binder
- decrease PO4

- calcitriol
- cinacalcet

- when PTH > 600 pg/mL after first line treatment
- usually used in combination with vitamin D treatment

intermittent dialysis (IDH)

- for stable patients
- acute hemodialysis
- indicated in AKI

continuous renal replacement therapy (CRRT)

- for hemodynamically unstable patients
- acute hemodialysis
- indicated in AKI

three times a week

hemodialysis frequency

Phoslo 667 mg PO TID

HF (male) has stage 4 CKD. Phos: 6.1, Hgb: 14.2, Ca: 9.1, Alb: 4. What is the most appropriate therapy for HF at this time?

A. Kayexelate 30g PO QD
B. Sevelamer 800 mg PO TID
C. Darbepoetin alfa
D. Phoslo 667 mg PO TID