Desired PTH, hypophosphatemia & low-normal calcium
Patient Scenario: Desired PTH, hypophosphatemia & low-normal calcium
Assessing the Clinical and Laboratory Parameters
A patient who falls into this category has optimal management based on current knowledge. It is important to note that patients values tend to vary from month to month particularly with serum phosphate. Therefore, ongoing counseling is indicated.
Less than 1% of all patients are in this category.
The calcium content of the dialysis bath could be raised. This would not be expected to affect phosphate control, but might result in suppression of PTH. The most frequent dialysate calcium is 1.25 mmol/L but this could be raised to 1.50 or even 1.75 mmol/L.
Correction of hypophosphatemia may also be attempted by adding phosphate to the dialysate. A common goal is 0.5 or 1.0 mmol/L of phosphate.
KDIGO Guideline 4.1.3 in patients with CKD stage 5D we suggest using a dialysate calcium concentration between 1.25 and 1.5 mmol/L (2.5 and 3.0 mEq/L)(2D).