11/23/2023 0 Comments Caesium phosphide formula92 Patients with Ca-P product above 72 (20% of all patients) had a 34% higher relative risk of death compared to patients with Ca-P product in the range of 42 to 52. It seems, however, that calcium supplementation should be considered in CKD patients when serum levels of PTH begin to rise, ie, GFR <60 mL/min/1.73 m 2 (Stage 3 CKD).Īn association was observed between Ca-P product and the risk of death in a random sample of the US population of 2,669 patients treated for at least 1 year with hemodialysis between 19. However, determining when to initiate calcium therapy in patients with CKD involves a consideration of multi-dimensional biological parameters on the part of the clinician. Certainly, in the presence of overt hypocalcemia, calcium supplementation is indicated. The question as to when to initiate calcium supplementation during the course of CKD is not answered by the available data in the literature. Further, the data are not helpful in deciding whether it is better to give the calcium salts in 1 dose per day or divided into multiple doses. Similarly, the 4 studies cited above did not provide information that could be utilized to ascertain whether giving the calcium salts before, during, or after meals is more effective. Therefore, the recommendation for the use of calcium carbonate for calcium supplementation in this Guideline is opinion-based and endorsed by the Work Group. Because of the different study conditions and patient populations, and because these studies did not directly address the question being asked, it was not useful to conduct a meta-analysis. The other 3 studies compared the use of calcium carbonate to placebo or no calcium supplement. However, this study followed the patients for only 3 hours after administration of the calcium supplements, and therefore the results represent only short-term effects. 41, 173, 205,206 Only 1 of these studies 206 directly compared the efficacy of 2 different calcium salts (calcium carbonate versus calcium citrate). The effectiveness of different calcium salts used for calcium supplementation was partially addressed by 4 studies. (OPINION) See Guideline 5.Ħ.5 The serum calcium-phosphorus product should be maintained at 2.0 g/day) should be avoided. (OPINION) See Guideline 8B.Ħ.3c If hypercalcemia (serum levels of corrected total calcium >10.2 mg/dL ) persists despite modification of therapy with vitamin D and/or discontinuation of calcium-based phosphate binders, dialysis using low dialysate calcium (1.5 to 2.0 mEq/L) may be used for 3 to 4 weeks (OPINION) See Guideline 9.Ħ.4 Total elemental calcium intake (including both dietary calcium intake and calcium-based phosphate binders) should not exceed 2,000 mg/day. (OPINION) See Guideline 5.Ħ.3b In patients taking active vitamin D sterols, the dose should be reduced or therapy discontinued until the serum levels of corrected total calcium return to the target range (8.4 to 9.5 mg/dL ). (OPINION)Ħ.3 In the event corrected total serum calcium level exceeds 10.2 mg/dL (2.54 mmol/L), therapies that cause serum calcium to rise should be adjusted as follows:Ħ.3a In patients taking calcium-based phosphate binders, the dose should be reduced or therapy switched to a noncalcium-, nonaluminum-, nonmagnesium-containing phosphate binder. In CKD Patients With Kidney Failure (Stage 5):Ħ.2 Serum levels of corrected total calcium should be maintained within the normal range for the laboratory used, preferably toward the lower end (8.4 to 9.5 mg/dL ). SERUM CALCIUM AND CALCIUM-PHOSPHORUS PRODUCTĦ.1 The serum levels of corrected total calcium should be maintained within the "normal" range for the laboratory used. NKF KDOQI Guidelines NKF KDOQI GUIDELINES KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |