A balanced view of calcium and
phosphate homeostasis in
chronic kidney disease
Calcium balance in normal individuals and in patients
with chronic kidney disease on low- and high-calcium
diets
Calcium balance in chronic kidney
disease: walking the tightrope
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Would reading these studies change your clinical practice? And how?The lesson learned here is large calcium supplements or binders should be avoided, especially in CKD patients, and calcium can be taken with limitations to avoild tissue and vascular calcification
Several measures, such as PTH, bone specific ALK, Ca PO4, vit D, with dexa scan, isotope method for vascular and tissue calcification, should be evaluated together
YES
Here is a suggested answer:
Yes. Being more conservative while prescribing calcium in asymptomatic CKD patients. There is ample evidence that patients with CKD are more susceptible to a positive calcium balance which increases their risk of VC and mortality.
That total elemental calcium intake should be within 800–1200 mg/d to prevent calcium defficiency and calcium loading, respectively.
It implies that calcium supplements and calcium-containing phosphate binders are virtually completely to be avoided in CKD, even in patients not yet on dialysis.
Positive calcium balance is associated with cardiovascular calcification and arterial stiffness.
More studied are required to asses calcium balance.
yes these studies will change my practice
the lesson learned here is calcium balance in CKD later stages is positive
and should use calcium with caution .
to assess the CKD MBD other parameter should checked to assess also the cv mortality .
Far from details about specific findings and numbers, these studies enlightened me in regard to the importance of calcium load in CKD/ESKD patients. The limitation of calcium load either by supplements or ca-based P binders needs to revisit. We need to aim for the least near-normal calcium and concentrate on phosphorous within normal range
Would reading these studies change your clinical practice? And how?yes
i think it helped us to understand more the pathophysiology of CaPO4 metabolism under the big title CKD MBD and if we understand the pathophysiology we can easily UNDERSTAND the plan of management
we understood tht our ckd patients could be easily in positive ca balance so giving Ca should be limited to avoild tissue and vascular calcification
we shouldnt depend on just Ca level in managing ckd patient, theres many parameters should be assessed togother like PTH, bone specific ALK, Ca PO4, vit D, with dexa scan, isotope technique for vascular and tissue calcification
Of course
these findings suggest that elemental calcium intake should be limited to 800–1200mg in individuals with late stage 3 or stage 4 CKD who are not on active vitamin D analogs, and possibly to 800–1000mg in subjects receiving active vitamin D
serum calcium cannot be used as a guide to evaluate calcium balance, and normal serum calcium concentrations do not preclude calcium loading.
in adults with CKD, total elemental calcium intake should be within 800–1200 mg/day to prevent calcium deficiency and calcium loading.
This will help to avoid soft tissue Ca deposition with its harmful impact on those patients.
yes. in my opinion , it changed the old idea that CKD patients are always in negative calcium balance related to active vit D defiency and acc. to these studies , CKD patients are in markrd positive calcium balance when supplied with calcium which will change our practice regarding calcium supplemention in CKD patients.
Yes , Helped us to don’t look only for Figueres and only to bring them in required targets , but to look to effect of usually prescribed medications for CKD patients on overall systems of body .
Yes
Avoid large calcium supplements or binders specially in ckd patient not only depends on calcium level, also negative balance in low calcium supplements may aggregate osteoporosis.
Monitor CKD-MBD parameters as iPTH will decrease with high calcium load
Active vitamin D to be given according to it’s level as it decrease with high calcium load
Monitor phos level and avoid high phos diet
Yes
by avoiding calcium supplement and calcium based phosphate binders in CKD patients.
yes
yes.
Yes they would
I may not aim to normalize serum Calcium, mild reduction in serum calcium are tolerable
Yes
Balanced calcium early in CKD
Avoid calcium load.
Hypophosphatemia is noted in early CKD2-3.
Ca, PO4 are tightly regulated until advance CKD
Yes these studies are change the clinical practice according to ca as a supplement when given to pt determine age sex and other parameters like po4 pth and not give ca as routine
yes positive balanced in CKD patients is detrimental
aim for low normal serum calcium
monitor CKDMBD parameters as per KDIGO guidelines
use of calcium binders cautiously
yes
dont give calcium element as routine supplement
shoud be follow the GUIDLINES .
yes should take care when provide calcium element as supplement
to avoid calcium load and positive status
# calcium load risk for cardiovascular calcification and increased the mortality rate in CKD
Yes. In order to prevent a positive balance, I will make sure that CKD patients maintain low, normal blood calcium levels. Avoid a positive calcium balance to prevent vascular calcification. but it is not a general rule. Individual evaluation and background are important for the decision.
But, I don’t think this is applied to all age groups. During their growing years, children require a positive calcium balance.
-Would reading these studies change your clinical practice? And how?
No , because of short time and small size and because of mostly 70% patient in ckd 3-4 without calcium supplementation have vascular calcification what negligate the role of extra calcium supplements. These study dont gave a hard evidence of calcium harm effect
Would reading these studies change your clinical practice? And how?
Nice comment, Dr. Omar. I think you got the message very clear.