Thursday, July 9, 2015

Monitoring in Phosphate Binder Therapy

Calcium Carbonate

  • are well tolerated and a cost effective first line treatment option for hyperphosphatemia. 
  • Using principally calcium‐containing phosphate binders increases the risk of positive calcium balance especially if concomitant use of vitamin D increasing the risk of vascular calcification and arterial disease. 
  • Serum calcium should be maintained within normal ranges to avoid hypercalcaemia

Monitoring

  • No specific recommendation for monitoring parameters
  • Recommended titration is 1-6 monthly based on Calcium and Phosphate levels

Disease

  • Monitoring depends on conditions and indications.
  • For example, hypercalcaemia and hypocalcaemia may changes in ECG (QT interval), which may necessitates more frequent monitoring
  • Calcium salts may also enhance the arrythmogenic effects of digoxin

Animal Study

  • Based on animal studies, level of phosphate is shown to drop significantly even at a period of 2 weeks. Drop is seen consistent over a period of 10 weeks.

Routine Monitoring

  • Phosphate level monitoring is routinely conducted in patients with CKD
  • This depends on the severity and disease level

References:

  1. http://emedicine.medscape.com/article/241185-workup
  2. http://www2.kidney.org/professionals/KDOQI/guidelines_pedbone/guide6.htm
  3. http://ndt.oxfordjournals.org/content/19/suppl_1/i19.full
  4. http://www.nursing.health.wa.gov.au/docs/career/np/SMAHS/AKDH_Management_Hyperphosphataemia

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.