Metabolic Acidosis

Epidemiology and Etiology

Approximately 80% of patients with a GFR less than 20 to 30 mL/min/1.73 m develop metabolic acidosis.55 Metabolic acidosis can increase protein catabolism and decrease albumin synthesis, which promote muscle wasting, and alter bone metabolism. Other consequences associated with metabolic acidosis in CKD include worsening cardiac disease, impaired glucose tolerance, altered growth hormone and thyroid function, and inflammation.55

Table 26-7 Dosing Recommendations for Vitamin D in Patients with CKD

Jiriritl PTH (pg/mL)

Erqoiiltifirol

Ciltllfiol Do irCL

Paricalcitol Dose

Doxer calciferol Dose

Stage J or 4 CKD

30-300°

*** JCK&SfMW

0J5 iTioyji ally daily

1 mifl C*aiy daily

2-5 mfl orally i lirtiiij

IU orally once or

or 2 mog orally J

week

CMfCR-wHkly

linviid viee*

900 IU «illy (telly

Stage S CKD on Hemodialysis

70-JW

N/A

0.25-0.S mtgOfil^'diiiV

1-2 mpj orally (Lilly

2.5 rrli| oi.illy 3 jbot

w«*iior dally

30D-6BV

N/A

05-1.S rlKT)

2-i-S meg IV per Itfi

S mcg or illy per Hf)

pot" IV pM JH?

2 iTn.-glVpcf HD

MMMjOOO'

NM

H meg orally pel HD

6-10 mcg M per HO

5-It) meg orally pet HD

1 }nVqW|*T HD

2-4 ir*^ W p^T Hf)

Gi&Nei Lhan 1JJOO

N/A

3-7 rttcgcuallyp« HD

»-IS nVcflVpcrHD

10 XI mutt orjlly pw

J-i meg IV par HO

■1-8- nvDg 1'iiper HD

Stage S CKD (M> Peritoneal Dialysis

Greater than 300'

WA

O.Vii meg orall/dally

Not leiommeoded

ti-S mogoralty

■fli-l meg orally 2-J times a

2-J times a week

warii

C KA chronic kdney disease; HD, hMividulysli; PTH, parathyroid horirono.

■I: itrutin t^ki^Bfi liiiilwn^.5 -(in^L <2-3? iiViitd/U n 1^1 il Ins (hgnii mj^ltS. 1.1.49 r(irnol/U Ci-P F^odutl leii tlvin 55 nyjTcJL

i; sfnim uk^xn l«i than 9.1 intjAdL I nmral/1 I phosphorus lew than mcj/cIL (S./H rmmol/lJ. and t'a-P product Iks rhan bb nvr'M1 II M'lunu'.itium li*w th.^n ID rmjAK (2,5 nwTnmpbijjptKXUt liw than (t.Tft iiwiol/1 ), and Cj-Ppir>dut'i I™. than 5I> n*jV:Jl ■

C KA chronic kdney disease; HD, hMividulysli; PTH, parathyroid horirono.

■I: itrutin t^ki^Bfi liiiilwn^.5 -(in^L <2-3? iiViitd/U n 1^1 il Ins (hgnii mj^ltS. 1.1.49 r(irnol/U Ci-P F^odutl leii tlvin 55 nyjTcJL

i; sfnim uk^xn l«i than 9.1 intjAdL I nmral/1 I phosphorus lew than mcj/cIL (S./H rmmol/lJ. and t'a-P product Iks rhan bb nvr'M1 II M'lunu'.itium li*w th.^n ID rmjAK (2,5 nwTnmpbijjptKXUt liw than (t.Tft iiwiol/1 ), and Cj-Ppir>dut'i I™. than 5I> n*jV:Jl ■

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