It is a complex process that requires good communication between the nephrologist, the dietitian, and the patient. It is important to recognize the treatment goals, which vary according to the stages of CKD. Serum levels of calcium, phosphorus, and intact PTH should be measured in all patients with CKD and estimated GFR <60 mL/min. The National Kidney Foundation K/DOQI guidelines provide frequency of measurements and goals for serum phosphorus and PTH according to CKD stage, listed below 14 (Table 2). The treatment of secondary hyperparathyroidism basically consists of a low phosphorus diet, phosphate binders, vitamin D derivatives, calcimimetics, and even parathyroidectomy.
Walked Method
The goal of the first step is to optimize the levels of serum phosphorus and calcium (within the recommended ranges, depending on stage of CKD). This can be achieved by dietary restriction and the initiation of phosphate binders (calcium acetate, sevelamer, or lanthanum). In CKD stages III and IV, ergocalciferol should be considered if the 25-hydroxyvitamin D level is <30 ng/mL.
2 will be concentrate on the control over PTH and you will nutritional D profile through calcimimetics and you will/or supplement D analogues. When the calcium and you will phosphorus profile was near the top limitation of regular, then cinacalcet should be considered. In addition, at the calcium supplements levels nearer to the reduced restrict of typical, vitamin D analogues would be a much better alternatives.
In the 3, this new doses off phosphate binders, calcimimetics, and you can nutritional D analogues are going to be adjusted to get the K/DOQI philosophy.
Low-Phosphorus Eating plan
Having clients which have CKD levels III and you will IV (top B), a reduced-phosphorus diet plan can be initiated whenever solution phosphorus was significantly more than cuatro.six milligrams/dL assuming gel phosphorous is over 5.5 mg/dL into the people having CKD phase V (level An excellent), or when the measured undamaged PTH is over the target diversity of one’s CKD phase, despite regular amounts of phosphorus and calcium supplements (height A great).