Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Renal Osteodystrophy 1291

■Next correct Ca: target normal range: 8.4 to 9.5 mg/dl

■Calcitriol to increase gut Ca absorption and suppress PTH secretion:

➣Predialysis: oral

➣Dialysis: IV

■If corrected Ca or PO4 levels high, can try paricalcitol or doxercalcif-

erol

■PTH target for stage 5: 150–300 pg/ml (intact PTH)

➣If PTH higher despite calcitrol or other vitamin D analogs, try

calcimimetic agents that suppress PTH without increasing serum

Ca: Cinacalcet

➣If PTH is low, discontinue vitamin D

Side Effects & Contraindications

■Calcium acetate and calcium carbonate:

➣Side effects: nausea, hypercalcemia, hypophosphatemia

➣Contraindications:

Absolute: hypercalcemia

Relative: GI motility disorders

■Sevelamer HCl:

➣Side effects: nausea, other GI symptoms

➣Relative contraindication: GI motility disorders

■Lanthanium carbonate: nausea, vomiting, diarrhea, abdominal

pain, headache

■Calcitriol and other vitamin D analogs:

➣Side effects: hypercalcemia, hyperphosphatemia

➣Contraindications:

Absolute: hypercalcemia

Relative: hyperphosphatemia

Cinacalcet: hypocalamia, nausea, vomiting, diarrhea, myalgia

follow-up

■Serum PO4, Ca, albumin monthly for dialysis patients

■Serum PTH q 3 mo in dialysis patients

■Test less frequently in predialysis patients

complications and prognosis

Complications

■Tertiary hyperparathyroidism: parathyroid hyperplasia not sup-

pressed by high serum Ca; causes bone injury and hypercalcemia;

may require parathyroidectomy

■Hypocalcemia postparathyroidectomy: may require IV Ca postop

(hungry bone syndrome)