Patient Scenario: Desired PTH, hyperphosphatemia and hypercalcemia
Assessing the Clinical and Laboratory Parameters
Phosphate control is suboptimal in this patient. Assess dietary intake, binders and timing of binders with meals.
Assess use of vitamin D and Calcimimetics. The PTH level is at the target range, which may be due to the current use of vitamin D sterols in an effort to control hyperparathyroidism. The vitamin D sterol may be increasing both the calcium and the phosphate absorption. It is likely that the hypercalcemia is also contributing to the current PTH level.
It is unusual to see hyperphosphatemia and hypercalcemia in a patient receiving calcimimetics
Approximately 4% of all patients are in this category.
Nocturnal dialysis may be a good option for this patient as this modality has been shown to lower phosphorus. Lowering the dialysis calcium bath could be considered, but this would not be expected to improve phosphate control, and may provide a stimulus to increase PTH.