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CKD-MBD — ESENeph MCQ

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ModerateHaemodialysisCKD-MBDESENeph

A 62-year-old man on haemodialysis has the following results: corrected calcium 2.65 mmol/L, phosphate 2.1 mmol/L, PTH 85 pmol/L (reference 1.6-6.9). He is on Sevelamer 800 mg TDS and Alfacalcidol 0.5 mcg daily. What is the most appropriate next step?

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Correct answer: C — Reduce or stop Alfacalcidol

The patient has hypercalcaemia and elevated PTH. The combination of hypercalcaemia with a moderately elevated PTH suggests that Alfacalcidol (active vitamin D) is contributing to the hypercalcaemia. KDIGO CKD-MBD guideline suggests limiting the use of calcium-based phosphate binders and active vitamin D analogues in the presence of hypercalcaemia. Alfacalcidol should be reduced or stopped. Cinacalcet could be considered for the PTH but the immediate priority is correcting hypercalcaemia.

Reference: https://guidelines.ukkidney.org