Secondary hyperparathyroidism — ESENeph MCQ

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HardRenal Bone Disease and Renal AnaemiaSecondary hyperparathyroidismESENeph

A haemodialysis patient has phosphate 2.2 mmol/L, normal corrected calcium and markedly elevated PTH. Review shows frequent missed binders and phosphate-additive intake. What is the most appropriate first response?

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Correct answer: B — Review binder adherence and diet with renal dietitian

The best answer is “Review binder adherence and diet with renal dietitian”. NICE requires dietary assessment, correct binder use with phosphate-containing food and review of dialysis adequacy. Escalation is meaningful after adherence, additives and nutrition have been addressed. “Perform parathyroidectomy before correcting phosphate exposure” is less appropriate because reversible drivers and treatment adherence should be addressed before irreversible surgery “Stop dialysis because it is causing hyperphosphataemia” is less appropriate because dialysis contributes phosphate clearance and should instead be assessed for adequacy “Give unrestricted phosphate-rich processed foods to improve protein intake” is less appropriate because additives are highly absorbable and diet can be adjusted without causing malnutrition “Increase active vitamin D without considering phosphate control” is less appropriate because vitamin D can increase calcium and phosphate absorption and does not correct missed binders

Reference: NICE NG203: CKD assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations