Rational use of vitamin D and calcium in the treatment of renal osteodystrophy

Rational use of vitamin D and calcium in the treatment of renal osteodystrophy

The treatment of renal osteodystrophy in principle and should pay attention to the problem in general, including the treatment of renal osteodystrophy and disorders of calcium and phosphorus metabolism measures: to reduce the intake of phosphorus and phosphorus removal to promote the control of hyperphosphatemia; adding calcium and active vitamin D3, adjust calcium to maintain its safety level and avoid the occurrence of hypercalcemia and prevention; treatment of secondary hyperparathyroidism; drug therapy can be considered parathyroid surgery.

The reduction of phosphorus treatment diet and dialysis treatment due to various reasons difficult to spread. Oral phosphate binders to promote the excretion of phosphorus has become the main means of treatment to control blood phosphorus level. The current clinical use of oral phosphate binders include aluminum containing agents such as aluminum hydroxide, calcium preparations such as calcium carbonate, calcium acetate; non calcium / aluminum agents such as hydrochloric acid Secretary Rahm, etc.. The main use of lanthanum carbonate and calcium carbonate or calcium acetate, side effects of such preparations is the largest hypercalcemia, and vitamin D and preparation of combined application of high calcium dialysate used under the condition of side effects is more obvious, and the development of long-term use of calcium and vascular calcification in dialysis patients.

Drug treatment of hyperparathyroidism in the treatment of active vitamin D mainly active vitamin D preparations such as ossification in three alcohol (1,25 (OH) 2D3) and alfacalcidol (1 alpha (OH) D3) and vitamin D analogs such as 22- oxa ossification in three alcohol (22-oxa-1 alpha, 25- (OH) 2D3). Paricalcitol (19-nor-1 alpha, 25- (OH) 2D2) and doxercalciferol (1 alpha (OH) D2). Clinical study demonstrated that vitamin D analogs had little effect on calcium and phosphorus levels in patients, but currently the main use of ossification in three alcohol and alfacalcidol. New drugs of calcium sensitive receptor agonist agent (calcimimetic) in the United States have begun to put into use, is considered the treatment of secondary hyperparathyroidism is currently the most promising drugs. CKD 3,4,5 patients, plasma PTH than the corresponding target range (CKD 3 >70 pg/ml, CKD 4 >110 pg/ml CKD >300 pg/ ml, 5), the need for the activity the activity of Vitamin vitamin D agents. Serum levels of calcium, phosphorus, <9.5, mg/dl (2.37 mmol/L), serum phosphorus, <4.6, mg/dl (1.49 mmol/L) must be corrected before treatment with vitamin D

Attention should be paid to the course of the treatment:

First of all, hyperphosphatemia must be controlled so as to avoid the excessive calcification of calcium and phosphorus, resulting in difficult reversal of metastatic calcification;

Phosphorus binder Aluminium Hydroxide Gel should not be used in order to avoid the storage of aluminum. After the control of hyperphosphatemia, it should be appropriate to use calcium carbonate during the maintenance period; if calcium phosphorus products are not high, calcium carbonate should be used first;

Should observe the serum calcium regularly, lest the damage caused by excessive blood calcium, when the blood calcium is greater than 2.75 mol/L, should stop the medicine in time;

The appropriate to reduce the concentration of dialysate calcium: such as dialysate calcium concentration is less than 1.25-1.75 mol/l (5 ~ 7 mg/dl), can significantly reduce the incidence of hypercalcemia;

Not for the use of 1,25 (OH) 2D3 patients, the first choice of small dose treatment. If patients have poor effect or hard to correct high parathyroid hormone level, may consider the use of intravenous or oral administration of 1,25 (OH) 2D3 shock treatment.