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Desired PTH, hyperphosphatemia and low or normal calcium

Patient Scenario: Desired PTH, hyperphosphatemia and low or normal calcium

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Assessing the Clinical and Laboratory Parameters

Phosphate control is suboptimal in this patient. 

The PTH level is at the target range in this patient.  This may be as a result of current use of vitamin D sterols in an effort to control hyperparathyroidism.  However, it may be that the vitamin D sterol is adversely influencing phosphate balance by increasing absorption.


Approximately 4% of all patients are in this category.


Therapeutic Options:


Dialysis Prescription

Dialysis Prescription

A reduction in dialysate calcium may permit an increase in the amount of calcium containing binder that could be used without inducing hypercalcemia.  Significant prolongation of dialysis time, specifically nocturnal, would enhance phosphate clearance.


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