CKD-MBD: A “Resistant” Case

Abstract

The following report describes the case of a stage V CKD patient (according to the K/DOQI classification) with secondary hyperparathyroidism and hypocalcemia; the patient's condition did not improve with hemodialysis treatment or with oral calcium and vitamin D analogue supplements. Also, parathyroidectomy did not lead to an improvement of the clinical picture; by contrast, an improvement was achieved by contemporary administration of paricalcitol, cholecalciferol, and cinacalcet. Since the last 10 years the patient was on carbamazepine therapy, a cytochrome P450 inducer able to promote 25-OH vitamin D catabolismi and deficiency. Since the 25-OH vitamin D level was not checked at the first patient's evaluation, iatrogenic 25-OH vitamin D deficiency couldn't be assessed. The present case report highlights how the use of vitamin D analogues together with oral calcium supplementation and sub-total parathyroidectomy were not decisive in this patient. Conversely, the safe use of cinacalcet and 25-OH vitamin D supplements were more effective for controlling the clinical features of secondary hyperparathyroidism.