Strategies to stop calcification of blood vessels | |
Correct Hyperphosphatemia | - More and longer dialysis sessions (4 - 5 times/wk) - Dietary phosphate restriction: avoid colas and processed food; seek nutrition consult - Non Ca++ phosphate binder |
Correct Hypercalcemia | - Reduce Ca++ concentration in dialysis bath to 1.5 or 2 mEq/l; ovoid 2.5 mEq/l - Stop Ca++ based phosphate binder (Ca++ acetate) |
Correct Hyperparathyroidism | - Cinacalcet (medical parathyroidectomy) - Surgical parathyroidectomy in medically refractory cases |
Stop Vitamin D | - E.g. calcitriol |
Stop Warfarin | - Evaluate need for alternate anticoagulant - No data to justify anticoagulation for stroke prevention in atrial fibrillation in dialysis patients - Apixaban 2.5 mg bid in pulmonary embolism, deep vein thrombosis, mechanical valve (limited safety data) |
Convert to Hemodialysis from Peritoneal Dialysis |
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Strategies to promote decalcification of blood vessels | |
Sodium Thiosulfate | - Route and dose - Intravenous (standard): 25 gm if weight > 60 kg; 12.5 gm if weight < 60 kg: infusion in the last hour of dialysis - Subcutaneous (non standard) 0.25 to 0.75 gm (1 to 3 ml of 250 mg/ml); at the periphery and center of the lesion - Duration of iv infusion: minimum of 2 - 3 mos.; typical total duration of 6 mos. or until lesions completely heal |
Vitamin K | - Route and dose: 10 mg per so three times a week (normal daily vitamin k intake: 0.10 - 0.15 mg) |
Wound care and pain control | |
Debridement | - Surgical debridement for infected and wounds with exudates - Nonsurgical debridement for noninfected and dry wounds |
Hyperbaric Oxygen Therapy | - Delivery of 100% oxygen at 2.5 times the atmospheric pressure in a sealed chamber for 90 min - Aim for 20 - 30 sessions (optimal number unknown) - Reserved for refractory wounds |
Pain Control | - Fentanyl and methadone preferred in renal failure. Avoid morphine and hydromorphone because accumulating active metabolite can cause respiratory depression. |