Mineral and bone disorder in chronic kidney disease part 3

Kidney cartoon 4

 

Management:

Vitamin D

  • Cholecalciferol, the form of vitamin D that comes from sun exposure, can be given as a dietary supplement and will be converted to 25-hydroxyvitamin D by the liver
  • If kidney function is still intact, it will then be converted to calcitriol, the most active form and will help to suppress the development of secondary hyperparathyroidism.
  • Calcitriol, the most active form of vitamin D is used in chronic kidney disease for suppression of secondary hyperparathyroidism and is the preferred vitamin D in later stages of chronic kidney disease when kidney function is very poor. Cholecalciferol should still be used for 25-hydroxyvitamin D deficiency in advanced chronic kidney disease, including in combination with calcitriol.
  • Calcitriol is available for the indication of hypocalcemia due to renal disease. The major side effect of therapy with calcitriol is hypercalcaemia and hyperphosphataemia

 

Cinacalcet

  • Cinacalcet, a calcimimetic agent,can be used to treat hyperparathyroidism for individuals in dialysis
  • In people with chronic kidney disease and severe hyperparathyroidism who fail to respond to medical/pharmacological therapy, parathroidectomy should be considered, particularly when calcium or phosphate levels cannot be satisfactorily controlled
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