Chronic Kidney Disease (cont.)
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ESAs may have serious side effects. These include the risk of strokes, heart attacks, and blood clots. Worsening hypertension and seizures as well as serious allergic reactions are other side effects.
The calcium-based binders may cause hypercalcemia. Lanthanum and sevelamer do not contain calcium. While non-calcium based binders are much more expensive, the doctor may favor these if a patient's blood calcium levels are high. All phosphate binders may cause constipation, nausea, vomiting, bowel obstruction, and fecal impaction. Phosphate binders may interfere with the absorption of other medications if these are taken together. Always check with the doctor to confirm the suitability of taking these medications together with other drugs.
As kidney disease progresses, activated forms of vitamin D may be prescribed. These drugs include Calcitriol (Rocaltrol), Paricalcitol (Zemplar), or doxercalciferol (Hectorol). These drugs are prescribed to control secondary hyperparathyroidism when the correction of nutritional vitamin D deficiency, administration of calcium supplementation, and control of serum phosphate have been ineffective.
The use of activated vitamin D may cause hypercalcemia (high calcium levels). The symptoms of hypercalcemia include feeling tired, difficulty thinking clearly, loss of appetite, nausea, vomiting, constipation, increased thirst, increased urination, and weight loss. Other side effects include diarrhea, nausea, swelling, allergic reactions, viral infections, high blood pressure, inflammation of the throat and nose, and dizziness. The doctor will recommend regular blood tests to follow the patient's kidney function, calcium, phosphorus, and parathyroid hormone levels.
Pranay Kathuria, MD, FACP, FASN, FNKF
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