CKD Minral and Bone Disease

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Last updated 8:15 PM on 9/24/26
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13 Terms

1
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As GFR decreases, 

  • Phosphorous increases 

  • PTH increases

  • Calcium decreases


2
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Signs/Symptoms/LABS

  • Fatigue, musculoskeletal pain, soft tissue calcification 

  • ELEVATED: phosphorus, intact PTH


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NON-Pharm: 

  1. Dietary phosphorus restriction 800 - 1200 mg/day

  2. Dialysis; removes phosphorus 

  3. Parathyroidectomy


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PHARM:

  • phosphate binders

  • vitamin D

  • calcimemtics


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Phosphate binders

- binds phos in gut and decrease absorption 

  1. Take with meals 

  2. May impact absorption of other medications admin at same time 

  3. GI side effects (constipation)



Aluminmum based PB: very effective, but AVOID use due to safety 

  1. Can be used short term 2-4 weeks if phos > 7 mg/dL


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Calcium based Binders:

calcium carbonate (TUMS), calcium acetate

  1. Calcium acetate - RX = better binder than carbonate (less Ca absorption)

    1. Capsule, tablet, liquid 

  2. Use limited via hypercalcemia, may increase vascular calcification 

    1. Limit total calcium intake to 2000 mg/day


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Sevelamer

sevelamer hydrochloride (Renagel) - tablet only 

  • Sevelamer carbonate (Renvela); tablet and powder for suspension 

    • Non-absorbale binding resin

    • First line for stage 5 CKD

    • Decreases LDL and increases HDL cholesterol

    • BUT: high pill burden 


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Lanthanum carbonate (Fosrenol) 

  • chewable/crushable/sprinkable oral powder 

  • Low pill burden


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sucroferric oxyhydroxiyde (Velphoro)

iron based PB

  • CHEWABLE TABLET

  • Contains iron

  • NO IRON ABSORPTION FROM GUT


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ferric citrate (Auryxia) 

iron based PB

  • Tablet

  • IRON IS ABSORBED FROM GUT, may required IV iron dose reduction 

  • needs iron monitoring due to iron absorption from gut


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Vitamin D

- suppresses PTH synthesis and reduced PTH concentration 

  • ADE: hypercalemia and hyperphosphatemia


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vit D products

Products: 

  1. 25-OH vit D - NEEDS ACTIVATION IN THE BODY 

    1. Ergocalciferol 

    2. Cholecalciferol 

    3. Calcifediol 

  2. 1, 25 - OH vit D - activated products 

    1. Calcitriol (rocaltrol)

    2. Doxercaliferol (Hectorol)

    3. Paricalcitol (Zemplar)


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Calcimimetic Agents 

→ increases the sensitivity of calcium receptors to serum calcium and REDUCES PTH

  1. Cinacalcet (Sensipar)

    1. Oral agent 

  2. Etelcalcetide (Parsabiv) 

    1. IV agent 

Useful in patients with HIGH CALCIUM/PHOSPHATE/PTH concentrations 

  • May increase the risk of hypocalcemia