Medication and bone mineral disease

Healthy kidneys control the balance of mineral salts (such as potassium, sodium, calcium and phosphate) and produce active vitamin D, important in strengthening bones.

Vitamins

Some vitamins are water soluble (such as complex B vitamins) and so they can be removed during the hemodialysis treatment. Therefore, renal patients may need to take some vitamin supplementation.

Vitamin D helps to maintain calcium level in the organism and the level of a hormone called PTH (parathyroid hormone) which helps to keep bones strong and healthy.

When the kidney doesn’t function, it is incapable of producing active vitamin D, resulting in the change of calcium absorption from diet. Therefore, the nephrologist may need to prescribe an active form of vitamin D, such as alfacalcidol, paricalcitol, calcitriol….

In case of inactive vitamin D deficiency  supplements with cholecalciferol may be needed This medication contains the same substance formed by skin when exposed directly to UV B rays of sun, being this the best natural source of vitamin D.

Supplements with vitamin D have an important role on the prevention of secondary hyperparathyroidism, once vitamin D is essential to keep calcium and phosphate levels and consequently PTH under control.

Excess of vitamins can also be dangerous, so you should not take vitamin supplements without telling your doctor.

Phosphate binders

Phosphate, like calcium, gets in the bloodstream through food intake. In Renal Disease, phosphate elimination may be reduced, increasing the amount of phosphates in blood.

Phosphate excess consequences:

When phosphate is excessive in blood it binds with calcium from food and bones, making up complexes which may:

  • Bonded with calcium, build up in blood vessels and joints (calcifications),
  • Cause some inch and red eyes,
  • Turn bones fragile and brittle,
  • Build up in skin blood vessels– skin cells may not receive necessary nutrients and oxygen (calciphylaxis)


Treatment of excessive phosphate – Hyperphosphatemia

 

Dialysis Diet Medication
The amount of phosphate removed by dialysis is reduced. Reduce the intake of rich phosphate food Whendialysis and diet are not enough, medication prescription may be needed.

 

Phosphate binders are a medication which binds in the gout to the phosphate from food, reducing phosphate absorption. There are 3 types of binders:

  •  With calcium(ex. Calcium Carbonate)
  • With metals(ex. Lantanium Carbonate)
  • Without Calcium and without metals(ex.  sevelamer)


How should I take:

Phosphate binder should be taken immediately before or during meals.

Don’t forget to follow diet recommended by your nutritionist/dietitian and let your doctor know if you take some little snacks between main meals, so he can adjust, if necessary, medication doses. 

Cinacalcet

This medication helps to keep PTH (parathyroid hormone) levels stable. It’s action is similar to the calcium on parathyroid, and thereby it is also called as calcimimetic. 

It is another medication which may be used in Renal Disease to help bones keeping strong and healthy.