Question

Explain in depth the factors involved in calcium imbalance during CKD ( chronic kidney disease). Include the role of Vitamin D supplements, phosphate binder, and calcium supplements.

Answer 1

-- CHRONIC KIDNEY DISEASE (CKD) causes imbalance in bone metabolism and increases the risk of a type of bone disease called renal osteodystrophy. These imbalance also can cause calcium to deposit in the blood vessels and contribute to heart disease.And if calcium is low a calcium supplement may be prescribed.Sometimes,calcium based phosphorus binders are prescribed to treat both low calcium and high phosphorus levels.

How CKD Cause hypocalcemia :- Phosphate binds calcium avidly, causing acute hypocalcemia.Acute hypocalcemia secondary to hyperphosphatemia may also result from renal failure or excess tissue breakdown because of rhabdomyolysis or tumor lysis.In acute hyperphosphatemia,calcium is deposited mostly in the bone but also in the extra skeletal tissue.

Role of vitamin D supplements:-

-- Its not unusual for people with kidney failure to have low level of vitamin D.Your doctor may check your vitamin D level and if its low, order a supplement.Your doctor can tell you if a supplement is a good choice for you and if you need it.Always check with your physician before starting an over the country vitamin, mineral, diet supplement or medicine.These items may harmful to people with Chronic Kidney Disease, if not taken properly.

Role of Phosphate binder:-

-- They are typically used in people with Chronic Kidney Failure as they often have difficulty getting rid of the Phosphates that get into their blood, i.e, the serum Phosphate in Chronic kidney failure is typically elevated.

-- Phosphate binders help to pass excess phosphorus out of the body in the stool, reducing the amount of phosphorus that gets into the blood.Usually Phosphate binders are taken with in 5 to 10 minutes before or immediately after meals and snacks.

Calcium Supplements:-

-- There is a high prevalence of calcium supplementation in the general population and some recent data suggest that this may increase the risk of vascular calcification.Calcium based binders have been a standard treatment for hyperphosphatemia in patients with CKD.Though as effective as Phosphate binders, they provide a source of substantial calcium intake.

-- There are few guidelines on advised calcium intake in patients with renal failure;however, on the basis of existing data, it maybe safer to have the upper limit of calcium intake up to 1 gram.The old kidney disease outcomes quality initiative suggestions of limiting the calcium intake to 2 gram may need to be reconsidered.