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CKD-MBD — RACP Adult Medicine MCQ

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HardNephrologyCKD-MBDRACP Adult Medicine

A 60-year-old man with ESKD on haemodialysis develops severe pruritus, bone pain, and a PTH level of 980 pg/mL (target 2–9 times upper limit of normal). His calcium is 2.75 mmol/L and phosphate is 2.8 mmol/L. What is the most appropriate pharmacological intervention?

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Correct answer: C — Cinacalcet

With markedly elevated PTH and hypercalcaemia, cinacalcet (a calcimimetic) is the most appropriate choice. It reduces PTH secretion without increasing calcium or phosphate levels. Calcitriol and paricalcitol would worsen hypercalcaemia. Calcium-based phosphate binders are contraindicated in hypercalcaemia. Phosphate control with non-calcium binders (sevelamer, lanthanum) is also needed.

Reference: KHA-CARI – 2013 – CKD-MBD Guidelines; KDIGO – 2017 – CKD-MBD Update