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Vascular Calcification Binder Switch — ESENeph MCQ

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ModerateHaemodialysisVascular Calcification Binder SwitchESENeph

A 68-year-old man on haemodialysis has a calcified aortic valve on echocardiography. His calcium-phosphate product has been persistently elevated (>4.4 mmol2/L2). He has been on Calcium Carbonate as a phosphate binder. According to KDIGO 2017 CKD-MBD, what change should be made?

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Correct answer: A — Switch to a non-calcium-based phosphate binder

KDIGO 2017 CKD-MBD guideline suggests restricting the dose of calcium-based phosphate binders in patients with persistent hypercalcaemia, elevated calcium-phosphate product, or evidence of arterial/valvular calcification. Switching to a non-calcium binder (Sevelamer, Lanthanum Carbonate, or Sucroferric Oxyhydroxide) reduces further calcium loading. Sevelamer has evidence for reducing vascular calcification progression compared to calcium-based binders.

Reference: https://guidelines.ukkidney.org