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Calcium, Phosphate and Parathyroid Hormone Management

High levels of serum phosphate are commonly seen in stages 4 and 5 CKD. This, together with a tendency to low serum calcium, is the stimulus to PTH secretion, which results in secondary hyperparathyroidism. Prolonged secondary hyperparathyroidism may cause bone problems and vascular calcification.

The aims are to keep serum phosphate < 1.5 mmol/l and PTH values < 15 and the adjusted serum calcium in the normal range (2.12-2.63mmol/l)

This is achieved by

  • specialist dietary advice
  • oral phosphate binding agents e.g. Calcichew, Renagel to control phosphate intake
  • vitamin D analogues e.g. Alfacalcidol to suppress PTH secretion
  • supplement native Vitamin D when deficient

Manipulation of these treatments requires regular review of blood results and dietary intake.