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Skip to 0 minutes and 14 seconds Let’s talk about another kind of a phosphate binder which includes aluminum. And the aluminum contained product is very important. It has the highest binding potency. So but however aluminum is associated with direct toxicity to bone. So this is a very important issue that we need to always keep in our mind. And it’s also contributes to microcytic anemia. So because anemia is also very common in dialysis patient. So we need to remember aluminum has weakness on those issues. And also aluminium containing binding, binders, also contributed to dialysis encephalopathy. So we need to always worry about that.

Skip to 1 minute and 17 seconds Thus for aluminum-containing products, we always in just reserved for very severe hyperphosphatemia So the patients, use this kind of binder for only short time in acute phase. So we can select aluminum hydroxide or sucralfate. And follows patient with hypocalcemia, we need to supply those patient with some calcium supplement. We all know 1.5 gram per day as for normal people but for dialysis patients we need to supply we use higher level and when we are actually providing calcium supplement we need to always remember to calculate a calcium and phosphorus label and not to cause those accumulations. So let’s review about renal osteodystrophy.

Skip to 2 minutes and 24 seconds Because those electrolyte imbalance, finally, those patients may have some bone issues so those clinical manifestations includes bone pain, fracture, muscle weakness, and some patiens may actually have extraskeletal calcification.

Skip to 2 minutes and 45 seconds So goals of renal osteodystrophy therapy includes: we need to normalize those patients Calcium and phosphate level. And suppress the secondary hyper PTH and also prevent aluminum toxicity and extraskeletal calcification. So treatment of renal osteodystrophy, actually includes treatment of hyper phosphate amia and also providing Calcitriol to keep those calcium level in our target range. And also need to avoid aluminum toxicity and when a patient has a too much aluminum we may need to use deferoxamin And also in a patient with the PTH problem we probably need to finally select parathyroidectomy. So let’s review another complication So those patients in chronic renal failure, they may have anemia And usually, this kind of anemia is normochromic normocytic anemia.

Skip to 4 minutes and 8 seconds We all know that anemia is a symptom with many different pathophysiologies. But in a patient with renal diseases, the major pathophysiology is actually from decreased the EPO production. So, the treatment includes transfusion but it’s only reserved for those patients with acute blood loss and the major mainstay of therapy as EPO and for some of a patient they may need to have iron therapy.

Complications of ESRD : renal osteodystrophy and anemia

In this step, Prof. Chen introduces phosphate binder magnesium containing products and other complications for patients in chronic kidney failure.

Phosphate binder magnesium containing products have the highest binding potency. However, they are associated with direct toxicity to bone (osteomalacia), microcytic anemia, dialysis encephalopathy, and fatal neurologic syndrome.

Therefore, they should be reserved for severe hyperphosphatemia with high serum calcium, or for short term use for acute phase.

When providing calcium supplement as a treatment to hypocalcemia, we need to calculate a calcium and phosphorus label to avoid causing those accumulations.

For renal osteodystrophy, we need to learn the symptoms, goals, and the treatments. Besides, we still need to consider aluminum toxicity and PTH problem.

Ultimately, anemia is a common complication in chronic kidney failure. Due to decreased erythropoietin (EPO) production, the main treatments only have transfusion, EPO therapy, and iron therapy.

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This video is from the free online course:

Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University