Remedying calcium and phosphate problems in chronic kidney disease

摘要

As renal function declines,a variety of metabolic disturbances manifest them-selves.Some patients will have altered biochemistry when their renal impairment is fairly mild,but by the time renal failure has become severe(a glomerular filtration rate or creatinine clearance below l0ml/minute),most patients have abnormal serum calcium and phosphate levels(see Panel 1 for normal reference ranges),falling vitamin D levels,and rising levels of parathyroid hormone(PTH).These result in a variety of clinical symptoms.Attempts to correct such abnormalities include the use of vitamin D and calcium-based phosphate binders.Treatment is usually successful initially but there are worries that the therapeutic use of these products can contribute to cardiovascular and soft-tissue calcification in the long term.