Dear Experts ,

A patient 35 years old , on hemodialysis 2 years post transplant with the following results :PTH-2000pg/ml, with Ca-6.8 mg%, Ph-10.74 mg%... .

I ordered to increase calcium supplements to increase his calcium level as well as binding phosphate .also i started alphacalcidol injections post dialysis .

calcium level was improved reaching after 0ne month to 8.4 mg% with Ph reaching 7.6 mg %.one month later again Ph level shoots to 9.7 mg%.

should I continue on alphacalcidol injections ?

what about cinacalcet ?

sevelamer?

providing that the patient is having high serum uric acid reaching 9.2 mg%, and unusual high creatinine level reaching 17 mg% despite having regular hemodialysis .