KDIGO. PTH and Vitamin D

Size: px
Start display at page:

Download "KDIGO. PTH and Vitamin D"

Transcription

1 3.1.1We recommend monitoring serum levels of calcium, phosphorus, PTH, and alkaline phosphatase ac?vity beginning in CKD stage 3 (1C). In children, we suggest such monitoring beginning in CKD stage 2 (2D). REVISE: 1. Consider a change for adults to 3B Basis: 3A captures a very large popula?on of adults, many of whom are elderly, with stable renal func?on VOTE: 16/16 2. Consider a change In children to 3A VOTE: 1/1

2 3.1.2 In pa?ents with CKD stages 3 5D, it is reasonable to base the frequency of monitoring serum calcium, phosphorus, and PTH on the presence and magnitude of abnormali?es, and the rate of progression of CKD (not graded). AGREE but consider star?ng at 3B adults, 3A children

3 3.1.2 Reasonable monitoring intervals would be: In CKD stage 3: for serum calcium and phosphorus, every 6 12 months; and for PTH, based on baseline level and CKD progression. AGREE In CKD stage 4: for serum calcium and phosphorus, every 3 6 months; and for PTH, every 6 12 months. In stage 4 PTH every 3-12 months according to baseline values and trends

4 3.1.2 Reasonable monitoring intervals would be: In CKD stage 5, including 5D: for serum calcium and phosphorus, every 1 3 months; and for PTH, every 3 6 months. Sugges?on: add according to baseline values and trends In CKD stages 4 5D: for alkaline phosphatase ac?vity, every 12 months, or more frequently in the presence of elevated PTH (see Chapter 3.2). REVISE: (new evidence) Sugges?on: measure ALP or preferably b- ALP when available Because these are independent predictors of bone turnover, they could be measured in the presence or absence of an elevated PTH b- ALP is par?cularly relevant if ALP and other LFTs are elevated

5 SUGGESTIONS FOR FUTURE RESEARCH Assess other biomarkers of bone turnover, par?cularly resorp?on markers including TRAcP- 5b and serum CTX; We require further informa?on on the accumula?on of markers such as CTX and P1NP in CKD Correla?on of P1NP with bone histomorphometry in CKD would be useful, in view of its wide use, standardiza?on of the assay and its availability.

6 3.1.3 In pa?ents with CKD stages 3 5D, we suggest that 25(OH)D (calcidiol) levels might be measured, and repeated tes?ng determined by baseline values and therapeu?c interven?ons (2C). REVISE; remove might There is adequate evidence, including in people with CKD, that very low values of 25OHD are harmful to bone health and may have wider effects

7 3.1.3 We suggest that vitamin D deficiency and insufficiency be corrected using treatment strategies recommended for the general popula?on (2C). REVISE; Popula?on specificity and new data. Pa?ents with CKD differ from the general popula?on. Appropriate supplementa?on might beber reflect the management of vitamin D deficient or insufficient pa?ents with non CKD osteoporosis In this popula?on, 25OHD values 30 ng/ml (75 nmol/l) may be an appropriate target

8 3.1.3 We suggest that vitamin D deficiency and insufficiency be corrected using treatment strategies recommended for the general popula?on (2C). Dosing regimens have now been tested in pa?ents with CKD: low dose eg. 800 IU/day cholecalciferol/ ergocalciferol are effec?ve in reaching targets, as are weekly and monthly doses of cholecalciferol, with doses to 50,000 IU. General popula?on data suggests high dosees at increased intervals (such as 500,000 IU yearly) should be avoided Vitamin D2 (ergo) and D3 (chole) treatments may require different dosing and dose frequency.

9 SUGGESTIONS FOR FUTURE RESEARCH Assessment of bioavailable D in people with CKD. Data in this area will become available soon.

10 4.2.1 In pa?ents with CKD stages 3 5 not on dialysis, the op?mal PTH level is not known. However, we suggest that pa?ents with levels of intact PTH (ipth) above the upper normal limit of the assay are first evaluated for hyperphosphatemia, hypocalcemia, and vitamin D deficiency (2C). AGREE

11 4.2.1 It is reasonable to correct these abnormali?es with any or all of the following: reducing dietary phosphate intake and administering phosphate binders, calcium supplements, and/or na?ve vitamin D (not graded). REVISE: new data Agreement with vitamin D supplementa?on. Agreement with dietary P reduc?on. Discussion of phosphate addi?ves to food and differences in absorp?on dependent on food types.

12 4.2.1 It is reasonable to correct these abnormali?es with any or all of the following: reducing dietary phosphate intake and administering phosphate binders, calcium supplements, and/or na?ve vitamin D (not graded). REVISE: new data Ca supplements: ensure adequate dietary calcium, and if inadequate, cau?on with supplemental calcium, par?cularly as CKD progresses Opinion of the group that the cau?ous use of phosphate binders should be individualized. Available phosphate binders in CKD 3-5 will ohen be calcium- based.

13 4.2.2 In pa?ents with CKD stages 3 5 not on dialysis, in whom serum PTH is progressively rising and remains persistently above the upper limit of normal for the assay despite correc?on of modifiable factors, we suggest treatment with calcitriol or vitamin D analogs (2C). REVISE: new data PTH values above the upper normal range may be appropriate. Normal PTH values in CKD 4-5 may induce LBT. However very high PTH values in pre dialysis pa?ents will increase later risk of shpt Calcitriol will increase absorp?on of Ca and P

14 4.2.2 In pa?ents with CKD stages 3 5 not on dialysis, in whom serum PTH is progressively rising and remains persistently above the upper limit of normal for the assay despite correc?on of modifiable factors, we suggest treatment with calcitriol or vitamin D analogs (2C). REVISE: new data This needs to be seen as a component in a con?nuum of management rather than an isolated treatment More appropriately: Treatment with calcitriol or vitamin D analogs might be used

15 4.2.3 In pa?ents with CKD stage 5D, we suggest maintaining ipth levels in the range of approximately two to nine?mes the upper normal limit for the assay (2C). We suggest that marked changes in PTH levels in either direc?on within this range prompt an ini?a?on or change in therapy to avoid progression to levels outside of this range (2C). Agree 14/16, however REVISE: new data available or soon to be available including COSMOS and EVOLVE Comments and concerns: 9?mes is too high the range is too wide

16 4.2.3 In pa?ents with CKD stage 5D, we suggest maintaining ipth levels in the range of approximately two to nine?mes the upper normal limit for the assay (2C). We suggest that marked changes in PTH levels in either direc?on within this range prompt an ini?a?on or change in therapy to avoid progression to levels outside of this range (2C). Concerns regarding effects on bone and progression of parathyroid hyperplasia Concerns that acceptance of high values may reduce the efficacy of treatment strategies

17 4.2.3 In pa?ents with CKD stage 5D, we suggest maintaining ipth levels in the range of approximately two to nine?mes the upper normal limit for the assay (2C). We suggest that marked changes in PTH levels in either direc?on within this range prompt an ini?a?on or change in therapy to avoid progression to levels outside of this range (2C). Funding issues if high values of PTH are acceptable Concerns at the use of fold rather than a numerical value; however, we agreed that due to the variety of assays, this was acceptable providing there was assay standardisa?on A new paediatric range should be defined

18 4.2.4 In pa?ents with CKD stage 5D and elevated or rising PTH, we suggest calcitriol, or vitamin D analogs, or calcimime?cs, or a combina?on of calcimime?cs and calcitriol or vitamin D analogs be used to lower PTH (2B). AGREE Discussion: Control of P should be added These strategies reduce the risk of PTx Calcitriol and analogs reduce the risk of worsening bone architecture Management is sequen?al; considera?on of phosphate control before use fo VDRAs; although this is addressed in the next dot point

19 4.2.4 It is reasonable that the ini?al drug selec?on for the treatment of elevated PTH be based on serum calcium and phosphorus levels and other aspects of CKD MBD (not graded). It is reasonable that calcium or non- calcium- based phosphate binder dosage be adjusted so that treatments to control PTH do not compromise levels of phosphorus and calcium (not graded). AGREE with both dot points

20 4.2.4 In pa?ents with CKD stage 5D and elevated or rising PTH, we suggest calcitriol, or vitamin D analogs, or calcimime?cs, or a combina?on of calcimime?cs and calcitriol or vitamin D analogs be used to lower PTH (2B). We recommend that, in pa?ents with hypercalcemia, calcitriol or another vitamin D sterol be reduced or stopped (1B). AGREE: however sugges?on to also consider reduc?on of any Ca supplementa?on

21 4.2.4 In pa?ents with CKD stage 5D and elevated or rising PTH, we suggest calcitriol, or vitamin D analogs, or calcimime?cs, or a combina?on of calcimime?cs and calcitriol or vitamin D analogs be used to lower PTH (2B). We suggest that, in pa?ents with hyperphosphatemia, calcitriol or another vitamin D sterol be reduced or stopped (2D). AGREE: but con?nue na2ve vitamin D and dietary modifica?on

22 4.2.4 In pa?ents with CKD stage 5D and elevated or rising PTH, we suggest calcitriol, or vitamin D analogs, or calcimime?cs, or a combina?on of calcimime?cs and calcitriol or vitamin D analogs be used to lower PTH (2B). We suggest that, in pa?ents with hypocalcemia, calcimime?cs be reduced or stopped depending on severity, concomitant medica?ons, and clinical signs and symptoms (2D) AGREE

23 4.2.4 In pa?ents with CKD stage 5D and elevated or rising PTH, we suggest calcitriol, or vitamin D analogs, or calcimime?cs, or a combina?on of calcimime?cs and calcitriol or vitamin D analogs be used to lower PTH (2B). We suggest that, if the intact PTH levels fall below two?mes the upper limit of normal for the assay, calcitriol, vitamin D analogs, and/or calcimime?cs be reduced or stopped (2C). AGREE but REVISE; Addi?onal sources of calcium including supplemental calcium, phosphate binder calcium and dialysate Ca need to be considered

24 SUGGESTIONS FOR POTENTIAL NEW GUIDELINES Although numerical values will differ, biointact (PTH 1-84) assays for PTH may be used interchangeably with intact assays when implemen?ng these guidelines

25 4.2.5 In pa?ents with CKD stages 3 5D with severe hyperparathyroidism (HPT) who fail to respond to medical/pharmacological therapy, we suggest parathyroidectomy (2B). AGREE: comment that severe unremimng may be a more appropriate term

26 5.2 In pa?ents aher the immediate post- kidney- transplant period, it is reasonable to base the frequency of monitoring serum calcium, phosphorus, and PTH on the presence and magnitude of abnormali?es, and the rate of progression of CKD (not graded). AGREE: discussion point that aher the immediate post transplant period might need beber defini?on; e.g. 3 months

27 5.2 Reasonable monitoring intervals would be: In CKD stages 1 3T, for serum calcium and phosphorus, every 6 12 months; and for PTH, once, with subsequent intervals depending on baseline level and CKD progression. AGREE: Comment; Baseline is unclear; for PTH, the pre transplant value is ohen indica?ve of post transplant levels and will influence frequency of post transplant monitoring.

28 5.2 Reasonable monitoring intervals would be: In CKD stage 4T, for serum calcium and phosphorus, every 3 6 months; and for PTH, every 6 12 months. REVISE: This should be concordant with earlier CKD- 4 recommenda?on; for PTH, 3-12 months dependent upon baseline values and trends

29 5.2 In CKD stages 3 5T, measurement of alkaline phosphatases annually, or more frequently in the presence of elevated PTH (see Chapter 3.2). REVISE; As in the CKD guideline, the current guideline suggests ALP measurement as an adjunct to PTH assessment; However ALP/BALP/and other markers may be useful in conjunc?on with PTH, but also as a guide to management of post transplant bone, par?cularly when bisphosphonates or other therapies are being considered.

30 5.3 In pa?ents with CKD stages 1 5T, we suggest that 25(OH)D (calcidiol) levels might be measured, and repeated tes?ng determined by baseline values and interven?ons (2C). REVISE: This should be concordant with earlier CKD recommenda?on: tes?ng should be performed. Discussion that values of 25OHD are ohen insufficient and deficient in this pa?ent group, and can fall rapidly aher transplanta?on.

31 5.4 In pa?ents with CKD stages 1 5T, we suggest that vitamin D deficiency and insufficiency be corrected using treatment strategies recommended for the general popula?on (2C). REVISE: Management of low vitamin D levels in this popula?on will require different supplementa?on regimens than those applicable to the general popula?on

32 SUGGESTIONS FOR POTENTIAL NEW GUIDELINES Guidelines do not currently address the use of monitoring sex steroids, assessment of amenorrhea in pre menopausal women, female or male hormonal replacement or lifestyle factors aher transplanta?on.

33 SUGGESTIONS FOR POTENTIAL NEW GUIDELINES An assessment of the grounds to rou?nely use FGF 23 as a marker for CKD- MBD

Standard Medicare Part D* checklist

Standard Medicare Part D* checklist Standard Medicare Part D* checklist This checklist can help you receive Sensipar (cinacalcet) at the lowest possible cost. You can use this checklist if you: Have Standard Medicare Part D* prescription

More information

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D. Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many

More information

Considerations With Calcium And Vitamin D Supplementation

Considerations With Calcium And Vitamin D Supplementation Considerations With Calcium And Vitamin D Supplementation Activity Preview Calcium is an electrolyte involved in many systems in the body including bone health, nerve signaling pathways, muscle contractions,

More information

D. Vitamin D. 1. Two main forms; vitamin D2 and D3

D. Vitamin D. 1. Two main forms; vitamin D2 and D3 D. Vitamin D. Two main forms; vitamin D2 and D3 H H D3 - Cholecalciferol D2 - Ergocalciferol Technically, vitamin D is not a vitamin. It is the name given to a group of fat-soluble prohormones (substances

More information

NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Vitamin D and Bone Health CE APPLICATION FORM

NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Vitamin D and Bone Health CE APPLICATION FORM NATIONAL OSTEOPOROSIS FOUNDATION OSTEOPOROSIS CLINICAL UPDATES Vitamin D and Bone Health CE APPLICATION FORM First Name: Last Name: Mailing Address: City: State: Zip/Postal Code: Country: Phone Number:

More information

GUIDE FOR VITAMIN D IN CHILDHOOD

GUIDE FOR VITAMIN D IN CHILDHOOD GUIDE FOR VITAMIN D IN CHILDHOOD October 2013 Introduction There are many different recommendations for the prevention, detection and treatment of Vitamin D deficiency in the UK. The following is a practical

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testing_serum_vitamin_d_levels 9/2015 2/2016 2/2017 2/2016 Description of Procedure or Service Vitamin D,

More information

12-01- 31. Outline. Setting the Stage. Se#ng the stage for precep0ng drug therapy assessment Elements of drug therapy assessment Hierarchy Flow chart

12-01- 31. Outline. Setting the Stage. Se#ng the stage for precep0ng drug therapy assessment Elements of drug therapy assessment Hierarchy Flow chart 12-01- 31 Preceptor Development: Patient Care Process Drug Therapy Assessment Outline Se#ng the stage for precep0ng drug therapy assessment Elements of drug therapy assessment Hierarchy Flow chart Student

More information

Vitamin D. Frequently Asked Questions

Vitamin D. Frequently Asked Questions Vitamin D Frequently Asked Questions What is vitamin D? What is a vitamin? Why do we need vitamins? Is there more than one form of vitamin D? Where do I get vitamin D? How long should I be outdoors, and

More information

Parathyroid hormone (serum, plasma)

Parathyroid hormone (serum, plasma) Parathyroid hormone (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Parathyroid hormone (PTH) 1.2 Alternative names Parathormone 1.3 NMLC code 1.4 Description of analyte PTH is an

More information

Vitamin D (serum, plasma)

Vitamin D (serum, plasma) Vitamin D (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Vitamin D 1.2 Alternative names The term vitamin D covers a group of closely related naturally occurring lipid soluble compounds

More information

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D.

Vitamin D Deficiency and Thyroid Disease. Theodore C. Friedman, M.D., Ph.D. Vitamin D Deficiency and Thyroid Disease Theodore C. Friedman, M.D., Ph.D. Vitamin D deficiency and thyroid diseases Vitamin D is an important vitamin that not only regulates calcium, but also has many

More information

Guideline on Diagnosis & Management of Vitamin D Deficiency in Adults for Non-Specialists

Guideline on Diagnosis & Management of Vitamin D Deficiency in Adults for Non-Specialists Guideline on Diagnosis & Management of Vitamin D Deficiency in Adults for Non-Specialists January 2014 (Review date: Jan 2016) Contents Summary Flowchart... 2 Introduction... 3 Structure and mechanism

More information

Vitamin D Deficiency in Adults: Primary Care Guideline

Vitamin D Deficiency in Adults: Primary Care Guideline Vitamin D Deficiency in Adults: Primary Care Guideline The prevalence of vitamin D deficiency in the UK is 16% and around 50% of the UK adult population have vitamin D insufficiency in winter and spring.

More information

For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only OR for Specialist Use only

For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only OR for Specialist Use only For the use of a Registered Medical Practitioner or a Hospital or a Laboratory only OR for Specialist Use only Cholecalciferol Granules VITOMIN D3 COMPOSITION Each sachet of 1 g contains: Cholecalciferol

More information

Southern Derbyshire Shared Care Pathology Guidelines. Vitamin D

Southern Derbyshire Shared Care Pathology Guidelines. Vitamin D Southern Derbyshire Shared Care Pathology Guidelines Vitamin D Purpose of guideline Provide clear advice on when to measure vitamin D and identify patients with insufficiency and deficiency. To provide

More information

KDIGO. Active and Native Vitamin D

KDIGO. Active and Native Vitamin D Active and Native Vitamin D KDIGO Grahame Elder Department of Renal Medicine, Westmead Hospital Osteoporosis & Bone Biology Division, Garvan Institute of Medical Research, Sydney Disclosures Member of

More information

Vitamin D Deficiency in Adults

Vitamin D Deficiency in Adults Vitamin D Deficiency in Adults Around 50% of the UK adult population have vitamin D insufficiency in winter and spring, whilst the prevalence of vitamin D deficiency is 16%. 1 This means that in Wandsworth

More information

Shining a light on the Sunshine Vitamin Lin A. Brown,MD Dartmouth and DHMC

Shining a light on the Sunshine Vitamin Lin A. Brown,MD Dartmouth and DHMC Shining a light on the Sunshine Vitamin Lin A. Brown,MD Dartmouth and DHMC Vitamin D What do surfers have in abundance and maybe most of the rest of us lack? Vit D - a vitamin primarily obtained by man

More information

keywords calcimimetics, calcium-sensing receptor, chronic kidney disease, secondary hyperparathyroidism, vitamin D

keywords calcimimetics, calcium-sensing receptor, chronic kidney disease, secondary hyperparathyroidism, vitamin D Calcimimetics or vitamin D analogs for suppressing parathyroid hormone in end-stage renal disease: time for a paradigm shift? James B Wetmore and L Darryl Quarles* SUMMARY Considerable advances have been

More information

Abbreviations Nephrology II

Abbreviations Nephrology II Nephrology II BONE METABOLISM AND DISEASE IN CHRONIC KIDNEY DISEASE Sarah R. Tomasello, Pharm.D., BCPS Reviewed by Joanna Q. Hudson, Pharm.D., BCPS; and Lisa C. Hutchison, Pharm.D., MPH, BCPS Learning

More information

Press Information. Vitamin D deficiency

Press Information. Vitamin D deficiency DSM, Corporate Communications P.O. Box 6500, 6401 HJ Heerlen The Netherlands phone +31 (0) 45 578 2421 www.dsm.com Vitamin D is one of the essential nutrients for human health. Unlike other types of vitamins

More information

BULLETIN. Slovak Republic Ministry of Health

BULLETIN. Slovak Republic Ministry of Health BULLETIN Slovak Republic Ministry of Health Part 51-53 November 13, 2009 No. 57 CONTENTS: 52. Slovak Republic Ministry of Health Guidelines for the Diagnosis of Glucocorticoidinduced Osteoporosis 52. Slovak

More information

Fact Sheet on Vitamin D

Fact Sheet on Vitamin D Fact Sheet on Vitamin D DISCLAIMER: This Fact Sheet Does Not Constitute Medical Advice. This sheet is a compilation of recommendations by top researchers. These recommendations may or may not apply to

More information

NHS GGC Vitamin D Supplementation Frequently asked Questions

NHS GGC Vitamin D Supplementation Frequently asked Questions Pharmacy & Prescribing Support Unit NHS GGC Vitamin D Supplementation Frequently asked Questions In February 2012 the Scottish Government issued advice on supplements for groups at risk of vitamin D deficiency.

More information

Chronic Kidney Disease (CKD) Algorithm. Chronic Kidney Disease (CKD) Algorithm Page 1

Chronic Kidney Disease (CKD) Algorithm. Chronic Kidney Disease (CKD) Algorithm Page 1 Chronic Kidney Disease (CKD) Algorithm Chronic Kidney Disease (CKD) Algorithm Page 1 Chronic Kidney Disease (CKD) Algorithm (See NICE Clinical Guideline CG73 1 and Quality Standards 2 ) Who should have

More information

Public Assessment Report. Scientific discussion. Calcium and Vitamine D3 Alpex 1000 mg/880 IE, effervescent granules

Public Assessment Report. Scientific discussion. Calcium and Vitamine D3 Alpex 1000 mg/880 IE, effervescent granules Public Assessment Report Scientific discussion Calcium and Vitamine D3 Alpex 1000 mg/880 IE, effervescent granules (calcium carbonate and cholecalciferol) NL License RVG: 111783 Date: 12 March 2015 This

More information

Citation Hong Kong Medical Journal, 1998, v. 4 n. 1, p. 23-26. Creative Commons: Attribution 3.0 Hong Kong License

Citation Hong Kong Medical Journal, 1998, v. 4 n. 1, p. 23-26. Creative Commons: Attribution 3.0 Hong Kong License Title Effectiveness of calcium acetate as a phosphate binder in patients undergoing continuous ambulatory peritoneal dialysis Author(s) Choy, CBY; Lo, WK; Cheng, IKP Citation Hong Kong Medical Journal,

More information

Chronic Kidney Disease (CKD) and Diet:

Chronic Kidney Disease (CKD) and Diet: Chronic Kidney Disease (CKD) and Diet: Assessment, Management, and Treatment Treating CKD Patients Who Are Not on Dialysis An Overview Guide for Dietitians Revised April 2015 Table of Contents I. About

More information

Guidelines for the Treatment and Prophylaxis of vitamin D deficiency in children and adolescents

Guidelines for the Treatment and Prophylaxis of vitamin D deficiency in children and adolescents Corby Clinical Commissioning Group Kettering General Hospital NHS Trust Nene Clinical Commissioning Group Northampton General Hospital NHS Trust Northamptonshire Healthcare Foundation Trust Guidelines

More information

ALPHA D 3 0.5 mcg Capsules

ALPHA D 3 0.5 mcg Capsules "פורמט עלון זה נקבע ע"י משרד הבריאות ותוכנו נבדק ואושר". עלון מאושר: אפריל 2010 This leaflet format has been determined by the Ministry of Health and the content thereof has been checked and approved.

More information

Role of vitamin K2 in bone and vascular calcifica6on

Role of vitamin K2 in bone and vascular calcifica6on Role of vitamin K2 in bone and vascular calcifica6on Leon J Schurgers, PhD Associate Professor of Biochemistry MUMC + Norway, 28th of January 2012 Once upon a time a vitamin, once regarded as the Cinderella

More information

Vitamin D and Calcium Guideline

Vitamin D and Calcium Guideline Vitamin D and Calcium Guideline Vitamin D Functions of Vitamin D 2 Serum Levels 2 Deficiency 2 Toxicity 2 Dietary Reference Intakes 3 Sources of Vitamin D 3 Therapeutic Options 4 Adults 4 Children (0 18

More information

Presented by: Nicole Nisly, MD

Presented by: Nicole Nisly, MD Presented by: Nicole Nisly, MD About Today s Presentation I will discuss osteoporosis and focus on causes, treatment op;ons and preven;on I will discuss medica;ons and life style choices that can be of

More information

Vitamin D Deficiency in Older Patients

Vitamin D Deficiency in Older Patients Fourth Year Medical Students Required Written Patient Care Assignments Reflecting Awareness of Use of Vitamin D in Older Patients at Risk for Falling John Agens, M.D. Associate Professor in Geriatrics

More information

Endocrinology. Vitamin D and bone health National Osteoporosis Society Guideline 2013. What is the GP s role? Vitamin D physiology

Endocrinology. Vitamin D and bone health National Osteoporosis Society Guideline 2013. What is the GP s role? Vitamin D physiology Endocrinology Vitamin D and bone health... 182 - What is the GP s role?...182 - Vitamin D physiology...182 - Why do people become vitamin D deficient?...183 - Which foods contain vitamin D?...183 - What

More information

HOW HEALTH LITERACY WILL BE DEFINED IN FUTURE.

HOW HEALTH LITERACY WILL BE DEFINED IN FUTURE. HOW HEALTH LITERACY WILL BE DEFINED IN FUTURE. EPATIENTS, EHEALTH SERVICES AND EHEALTH LITERACY THE FORGOTTEN CORNER STONES OF CONTEMPORARY HEALTH LITERACY RESEARCH. EHEALTH LITERACY Defini0on from Norman/Skinner

More information

Vitamin D und seine Bedeutung im Immunsystem und bei der Infektabwehr

Vitamin D und seine Bedeutung im Immunsystem und bei der Infektabwehr Vitamin D und seine Bedeutung im Immunsystem und bei der Infektabwehr Stefan Pilz Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Austria Department

More information

DEFINITION OF OSTEOPOROSIS

DEFINITION OF OSTEOPOROSIS CHAPTER 27 OSTEOPOROSIS AND OSTEOMALACIA DEFINITION OF OSTEOPOROSIS THE EPIDEMIOLOGY AND CONSEQUENCES OF OSTEOPOROSIS REVIEW OF BONE REMODELING BONE LOSS PATHOGENESIS OF OSTEOPOROSIS DIAGNOSIS OF OSTEOPOROSIS

More information

PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES

PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES PROTOCOL FOR PATIENTS WITH ABNORMAL LAB AND X-RAY VALUES Patients newly diagnosed as osteopenic or osteoporotic on a radiology report or patients receiving abnormal lab values on the following lab tests

More information

DVITA PLUS Vitamin D 1000 IU Tablet INDICATED CLAIMS:

DVITA PLUS Vitamin D 1000 IU Tablet INDICATED CLAIMS: DVITA PLUS Vitamin D 1000 IU Tablet INDICATED CLAIMS: Vitamin D is the principal regulator of calcium homeostasis in the body Vitamin D is particularly important in skeletal development and bone mineralization.

More information

MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol)

MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol) MANAGEMENT OF COMMON SIDE EFFECTS of INH (Isoniazid), RIF (Rifampin), PZA (Pyrazinamide), and EMB (Ethambutol) 1. Hepatotoxicity: In Active TB Disease a. Background: 1. Among the 4 standard anti-tb drugs,

More information

Public Assessment Report. UK National Procedure. (colecalciferol) PL 16508/0047 PL 16508/0048. ProStrakan Ltd.

Public Assessment Report. UK National Procedure. (colecalciferol) PL 16508/0047 PL 16508/0048. ProStrakan Ltd. Public Assessment Report UK National Procedure STEXEROL-D 3 1,000 IU FILM-COATED TABLETS STEXEROL-D 3 25,000 IU FILM-COATED TABLETS (colecalciferol) PL 16508/0047 PL 16508/0048 ProStrakan Ltd. 1 LAY SUMMARY

More information

Drug treatments for osteoporosis

Drug treatments for osteoporosis Drug treatments for osteoporosis What is osteoporosis? Osteoporosis occurs when the struts which make up the mesh-like structure within bones become thin causing them to become fragile and break easily,

More information

Nutri+onal considera+ons for kidney transplant. Overview. Objec+ves 6/3/16. Bridging the gap between the renal RD and transplant clinic

Nutri+onal considera+ons for kidney transplant. Overview. Objec+ves 6/3/16. Bridging the gap between the renal RD and transplant clinic Nutri+onal considera+ons for kidney transplant Bridging the gap between the renal RD and transplant clinic Olivia Moss, MS, RDN, LDN Solid Organ Transplant Die++an and Clinical Nutri+on Instructor June

More information

25-hydroxyvitamin D: from bone and mineral to general health marker

25-hydroxyvitamin D: from bone and mineral to general health marker DIABETES 25 OH Vitamin D TOTAL Assay 25-hydroxyvitamin D: from bone and mineral to general health marker FOR OUTSIDE THE US AND CANADA ONLY Vitamin D Receptors Brain Heart Breast Colon Pancreas Prostate

More information

VITAMIN D PRODUCTS -WHAT AND WHEN TO PRESCRIBE. Claudette Allerdyce Principal Pharmacist Croydon CCG Pharmacy Team

VITAMIN D PRODUCTS -WHAT AND WHEN TO PRESCRIBE. Claudette Allerdyce Principal Pharmacist Croydon CCG Pharmacy Team VITAMIN D PRODUCTS -WHAT AND WHEN TO PRESCRIBE Claudette Allerdyce Principal Pharmacist Croydon CCG Pharmacy Team WHAT ARE THE ISSUES? A lack of suitable licensed vitamin D products in the UK for treating

More information

YOUR TRUSTED SOURCE - FOR ALL YOUR VITAMIN D 3 NEEDS

YOUR TRUSTED SOURCE - FOR ALL YOUR VITAMIN D 3 NEEDS Vitamin D YOUR TRUSTED SOURCE - FOR ALL YOUR VITAMIN D 3 NEEDS ü Natural form of vitamin D 3, cholecalciferol (from lanolin) ü Strengths from 400 iu to 10,000 iu ü Capsule and liquid forms available ü

More information

Earth at Night View from the Space Shuttle. Vitamin D: All You Need to Know

Earth at Night View from the Space Shuttle. Vitamin D: All You Need to Know Earth at Night View from the Space Shuttle Vitamin D: All You Need to Know Sunil Wimalawansa, MD, PhD, MBA 11/12/2011 Vitamin D: All You Need to Know Sunil J. Wimalawansa, MD, PhD, MBA, FACE, FACP Professor

More information

Use of Ultrasound to Assess the Response to Therapy for Secondary Hyperparathyroidism

Use of Ultrasound to Assess the Response to Therapy for Secondary Hyperparathyroidism Imaging Teaching Case Use of Ultrasound to Assess the Response to Therapy for Secondary Hyperparathyroidism Mario Meola, MD, PhD, 1,2 Ilaria Petrucci, MD, 2 Elisa Colombini, MD, 2 and Giuliano Barsotti,

More information

Question I. A vitamin D deficient mother will give birth. A. True B. False. Answer A

Question I. A vitamin D deficient mother will give birth. A. True B. False. Answer A Vitamin D Jatinder Bhatia, MD, FAAP Question I A vitamin D deficient mother will give birth to an infant with Vit D deficiency A. True B. False Answer A Question II Human breast milk has adequate amounts

More information

Vitamin D deficiency: the cause of everything?

Vitamin D deficiency: the cause of everything? Health problems linked to vitamin D deficiency: Vitamin D deficiency: the cause of everything? Louise Gagné M.D. Family Physician Saskatoon Community Clinic Clinical Assistant Professor Department of Community

More information

Vitamin D and Bone Health: A Practical Clinical Guideline for Management in Children and Young People

Vitamin D and Bone Health: A Practical Clinical Guideline for Management in Children and Young People Vitamin D and Bone Health: A Practical Clinical Guideline for Management in Children and Young People Vitamin D and bone health: a practical clinical guideline for management in children and young people

More information

PHARMACOLOGICAL PROPERTIES

PHARMACOLOGICAL PROPERTIES ANTİ-FOSFAT ca 700 mg Film Tablet COMPOSITION 1 film tablet contains 700 mg Calcium acetate, as an active ingredient. Excipients are Microcrystalline cellulose, Povidone K30, Crosspovidone, Magnesium stearate,

More information

UCSF Kidney Transplant Symposium 2012

UCSF Kidney Transplant Symposium 2012 UCSF Kidney Transplant Symposium 2012 Nutrition Fitness in Kidney Transplant Mary Ellen DiPaola, RD, CDE UCSF Outpatient Dietitian Goal of Nutrition Fitness for Transplant Nutritional guidance of pre-

More information

Treatment recommendations for patients with secondary

Treatment recommendations for patients with secondary Cinacalcet HCl and Concurrent Low-dose Vitamin D Improves Treatment of Secondary Hyperparathyroidism in Dialysis Patients Compared with Vitamin D Alone: The ACHIEVE Study Results Steven Fishbane,* Warren

More information

Reducing Recidivism and Promo1ng Recovery: Implemen1ng Effec1ve Programming for Individuals with Substance Use Disorders

Reducing Recidivism and Promo1ng Recovery: Implemen1ng Effec1ve Programming for Individuals with Substance Use Disorders Reducing Recidivism and Promo1ng Recovery: Implemen1ng Effec1ve Programming for Individuals with Substance Use Disorders Alexa Eggleston, J.D. Program Director, Substance Abuse The Jus;ce Center, Council

More information

Calcium (serum, plasma, blood)

Calcium (serum, plasma, blood) Calcium (serum, plasma, blood) 1 Name and description of analyte 1.1 Name of analyte Calcium (total in serum, plasma, ionised in blood (see 2.1 (2)). 1.2 Alternative names None 1.3 NMLC code 1.4 Description

More information

Vitamin D & Iron Dosing Guidelines

Vitamin D & Iron Dosing Guidelines Vitamin D & Iron Dosing Guidelines Ayman Khmour, MD I have no actual or potential conflict of interest in relation to this program. Objectives Review Ca metabolism Review Recent AAP Guidelines Review CMH

More information

Disability Evaluation Under Social Security

Disability Evaluation Under Social Security Disability Evaluation Under Social Security Revised Medical Criteria for Evaluating Endocrine Disorders Effective June 7, 2011 Why a Revision? Social Security revisions reflect: SSA s adjudicative experience.

More information

Towards an adequate intake of vitamin D

Towards an adequate intake of vitamin D Towards an adequate intake of vitamin D Gezondheidsraad Health Council of the Netherlands To the Minister of Health, Welfare and Sport Subject : Presentation of advisory report Towards an adequate intake

More information

Management of invasive procedures and bleeding compica5ons in pa5ents on NOACs

Management of invasive procedures and bleeding compica5ons in pa5ents on NOACs Management of invasive procedures and bleeding compica5ons in pa5ents on NOACs Michiel Coppens MD PhD Internist- Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands McMaster University,

More information

Cystic fibrosis and bone health

Cystic fibrosis and bone health Cystic fibrosis and bone health Factsheet March 2013 Cystic fibrosis and bone health Introduction As we get older our bones become thinner and weaker, and may become more susceptible to fracture. However

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) OSTEOPOROSIS GUIDELINE This is an updated guideline It incorporates the latest NICE guidance There are strong recommendations for calcium + vitamin D

More information

Guidance on Vitamin D Deficiency/Insufficiency November 2011 (updated February 2012)

Guidance on Vitamin D Deficiency/Insufficiency November 2011 (updated February 2012) Guidance on Vitamin D Deficiency/Insufficiency vember 2011 (updated February 2012) This guidance aims to provide general advice for clinicians in a community setting including areas where clinical uncertainty

More information

Fast Facts on Osteoporosis

Fast Facts on Osteoporosis Fast Facts on Osteoporosis Definition Prevalence Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an

More information

Questions and Answers for Health Care Providers: Renal Dosing and Administration Recommendations for Peramivir IV

Questions and Answers for Health Care Providers: Renal Dosing and Administration Recommendations for Peramivir IV Questions and Answers for Health Care Providers: Renal Dosing and Administration Recommendations for Peramivir IV The purpose of this document is to provide additional clarification to the existing information

More information

Maintenance of abstinence in alcohol dependence

Maintenance of abstinence in alcohol dependence Shared Care Guideline for Prescription and monitoring of Acamprosate Calcium Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist, Alcohol Services Dr Donnelly

More information

IT Change Management Process Training

IT Change Management Process Training IT Change Management Process Training Before you begin: This course was prepared for all IT professionals with the goal of promo9ng awareness of the process. Those taking this course will have varied knowledge

More information

meeting report http://www.kidney-international.org & 2015 International Society of Nephrology

meeting report http://www.kidney-international.org & 2015 International Society of Nephrology http://www.kidney-international.org & 2015 International Society of Nephrology Revisiting KDIGO clinical practice guideline on chronic kidney disease mineral and bone disorder: a commentary from a Kidney

More information

Medications for Prevention and Treatment of Osteoporosis

Medications for Prevention and Treatment of Osteoporosis 1 Medications for Prevention and Treatment of Osteoporosis Osteoporosis is a disease where the strength of bones is less than normal, making them more susceptible to fracture, or breaking, than normal

More information

ZEMPLAR (paricalcitol) Injection Fliptop Vial

ZEMPLAR (paricalcitol) Injection Fliptop Vial ZEMPLAR (paricalcitol) Injection Fliptop Vial DESCRIPTION Paricalcitol, USP, the active ingredient in Zemplar Injection, is a synthetically manufactured analog of calcitriol, the metabolically active form

More information

10/27/2010. CKD in the United States. Management of The Patient With Chronic Kidney Disease. CKD Patients Are More Likely to Die Than Progress to ESRD

10/27/2010. CKD in the United States. Management of The Patient With Chronic Kidney Disease. CKD Patients Are More Likely to Die Than Progress to ESRD CKD in the United States Management of The Patient With Chronic Kidney Disease Paul J. Scheel, Jr., M.D., FASN Director,Division of Nephrology An estimated 26 million adults have CKD Many are unaware of

More information

San Jacinto College Banner & Enterprise Applica5on Review Task Force Report. November 01, 2011 FINAL

San Jacinto College Banner & Enterprise Applica5on Review Task Force Report. November 01, 2011 FINAL San Jacinto College Banner & Enterprise Applica5on Review Task Force Report November 01, 2011 FINAL 1 Content Review goal and approach 3 Barriers to effec5ve use of Banner: Consultant observa5ons 10 Consultant

More information

David S. Lee, MPH. Campus sexual violence preven;on: An overview of opportuni;es and challenges in policy and programs

David S. Lee, MPH. Campus sexual violence preven;on: An overview of opportuni;es and challenges in policy and programs David S. Lee, MPH Campus sexual violence preven;on: An overview of opportuni;es and challenges in policy and programs APHA Annual Mee+ng, Chicago, IL, November 2015 Disclosures I have no disclosures to

More information

Vitamin D insufficiency prior to bariatric surgery: risk factors and a pilot treatment study

Vitamin D insufficiency prior to bariatric surgery: risk factors and a pilot treatment study Clinical Endocrinology (2009) 71, 176 183 doi: 10.1111/j.1365-2265.2008.03470.x ORIGINAL ARTICLE Blackwell Publishing Ltd Vitamin D insufficiency prior to bariatric surgery: risk factors and a pilot treatment

More information

OUTPATIENT MANAGEMENT OF CHRONIC KIDNEY DISEASE. Jeanie Park, MD MS Assistant Professor Renal Division Emory University School of Medicine

OUTPATIENT MANAGEMENT OF CHRONIC KIDNEY DISEASE. Jeanie Park, MD MS Assistant Professor Renal Division Emory University School of Medicine OUTPATIENT MANAGEMENT OF CHRONIC KIDNEY DISEASE Jeanie Park, MD MS Assistant Professor Renal Division Emory University School of Medicine Disclosures None Goals Background and staging Strategies to slow

More information

Symposium: Vitamin D Insufficiency: A Significant Risk Factor in Chronic Diseases and Potential Disease-Specific Biomarkers of Vitamin D Sufficiency

Symposium: Vitamin D Insufficiency: A Significant Risk Factor in Chronic Diseases and Potential Disease-Specific Biomarkers of Vitamin D Sufficiency Symposium: Vitamin D Insufficiency: A Significant Risk Factor in Chronic Diseases and Potential Disease-Specific Biomarkers of Vitamin D Sufficiency Dietary Recommendations for Vitamin D: a Critical Need

More information

Vitamin D Status: United States, 2001 2006

Vitamin D Status: United States, 2001 2006 Vitamin D Status: United States, 2001 2006 Anne C. Looker, Ph.D.; Clifford L. Johnson, M.P.H.; David A. Lacher, M.D.; Christine M. Pfeiffer, Ph.D.; Rosemary L. Schleicher, Ph.D.; and Christopher T. Sempos,

More information

PHOSPHATE-SANDOZ Tablets (High dose phosphate supplement)

PHOSPHATE-SANDOZ Tablets (High dose phosphate supplement) 1 PHOSPHATE-SANDOZ Tablets (High dose phosphate supplement) PHOSPHATE-SANDOZ PHOSPHATE-SANDOZ Tablets are a high dose phosphate supplement containing sodium phosphate monobasic. The CAS registry number

More information

Clinical Aspects of Hyponatremia & Hypernatremia

Clinical Aspects of Hyponatremia & Hypernatremia Clinical Aspects of Hyponatremia & Hypernatremia Case Presentation: History 62 y/o male is admitted to the hospital with a 3 month history of excessive urination (polyuria) and excess water intake up to

More information

Irish Medicines Board

Irish Medicines Board IRISH MEDICINES BOARD ACTS 1995 AND 2006 MEDICINAL PRODUCTS(CONTROL OF PLACING ON THE MARKET)REGULATIONS,2007 (S.I. No.540 of 2007) PA0030/038/001 Case No: 2075491 The Irish Medicines Board in exercise

More information

National. min. for early infancy. on Vitamin D. to get converted to action being. here. to treat an. will be insufficient

National. min. for early infancy. on Vitamin D. to get converted to action being. here. to treat an. will be insufficient ABUHB Prescribing Guideline Diagnosis and Management of Vitamin D Deficiency In ADULTS (including guidance for Non Specialists) This document aims to provide comprehensive guidance on the cost effective

More information

Vitamin D. Why Vitamin D is important and how to get enough

Vitamin D. Why Vitamin D is important and how to get enough Vitamin D Why Vitamin D is important and how to get enough Why is vitamin D vital for health? Vitamin D is needed by the body for both physical and mental health, but is best known for making sure bones

More information

Calcium, Parathyroid Hormone, and Vitamin D in Patients with Primary Hyperparathyroidism. Normograms Developed from 10,000 Cases

Calcium, Parathyroid Hormone, and Vitamin D in Patients with Primary Hyperparathyroidism. Normograms Developed from 10,000 Cases Calcium, Parathyroid Hormone, and Vitamin D in Patients with Primary Hyperparathyroidism. Normograms Developed from 10,000 Cases James Norman MD, FACS, FACE, Arnold Goodman MD, FACS, and Douglas Politz

More information

The effect of alcohol withdrawal on bone turnover in women with alcohol dependence

The effect of alcohol withdrawal on bone turnover in women with alcohol dependence The effect of alcohol withdrawal on bone turnover in women with alcohol dependence By Pallavi Wyawahare A thesis Submitted to Victoria University of Wellington in partial fulfillment of the requirements

More information

OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY VOLUME 76 SUPPLEMENT 113 AUGUST 2009. Supplement to Kidney International

OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY VOLUME 76 SUPPLEMENT 113 AUGUST 2009. Supplement to Kidney International OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder

More information

Hypocalcaemia. Shaila Sukthankar

Hypocalcaemia. Shaila Sukthankar Hypocalcaemia Shaila Sukthankar Ca Daily Requirements Age/ sex Ca (mg) 1-3 350 4-6 450 7-10 550 11-18 M 1000 11-18 F 800 19 + 700 Ca Dietary Sources (NDC) Milk 100 ml =120mg Cheese 15gm = 110mg Yoghurt

More information

Volume 9; Number 13 September 2015 TREATMENT OF VITAMIN D DEFICIENCY IN AT-RISK ADULTS (SECOND EDITION)

Volume 9; Number 13 September 2015 TREATMENT OF VITAMIN D DEFICIENCY IN AT-RISK ADULTS (SECOND EDITION) Arden and Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and

More information

Accountable Care Organizations: Implications for CHCs Serving AA&NHOPIs

Accountable Care Organizations: Implications for CHCs Serving AA&NHOPIs Accountable Care Organizations: Implications for CHCs Serving AA&NHOPIs Practice Transformation Webinar Series Webinar 4 April 29, 2015 Moderator: Nina Agbayani, Director of Programs About AAPCHO National

More information

Policy Clinical Guideline. Management of Vitamin D Deficiency in Children

Policy Clinical Guideline. Management of Vitamin D Deficiency in Children Policy Clinical Guideline Management of Vitamin D Deficiency in Children Policy developed by: SA Child Health Clinical Network Approved by SA Health Safety & Strategic Governance Committee on: 1 July 2013

More information

Steven K. Clinton, MD, PhD Professor Department t of Internal Medicine Division of Medical Oncology The Ohio State University Wexner Medical Center

Steven K. Clinton, MD, PhD Professor Department t of Internal Medicine Division of Medical Oncology The Ohio State University Wexner Medical Center Vitamin D: The 2011 Dietary Reference Intakes fo Vitamin D and Calcium Steven K. Clinton, MD, PhD Professor Department t of Internal Medicine i Division of Medical Oncology The Ohio State University Wexner

More information

Poten&al Impact of FDA Regula&on of EMRs. October 27, 2010

Poten&al Impact of FDA Regula&on of EMRs. October 27, 2010 Poten&al Impact of FDA Regula&on of EMRs October 27, 2010 Agenda The case for regula&ng Impact on manufacturers Impact on providers Recommenda&ons and best prac&ces 2 A Medical Device Is an instrument,

More information

HYPERTENSION ASSOCIATED WITH RENAL DISEASES

HYPERTENSION ASSOCIATED WITH RENAL DISEASES RENAL DISEASE v Patients with renal insufficiency should be encouraged to reduce dietary salt and protein intake. v Target blood pressure is less than 135-130/85 mmhg. If patients have urinary protein

More information

Advances in An+coagula+on

Advances in An+coagula+on Advances in An+coagula+on Laurajo Ryan PharmD, MSc, BCPS, CDE Clinical Associate Professor The University of Texas at Aus+n College of Pharmacy UTHSCSA School of Medicine Pharmcotherapy Research Educa+on

More information

Please stand up, with your entry 3cket in hand, and find a partner from another table. Round 1: Share one interven3on and the current stage of

Please stand up, with your entry 3cket in hand, and find a partner from another table. Round 1: Share one interven3on and the current stage of Please stand up, with your entry 3cket in hand, and find a partner from another table. Round 1: Share one interven3on and the current stage of implementa3on. Describe an opportunity that the interven3on

More information

Calcium and Vitamin D Supplementation: Who Needs It?

Calcium and Vitamin D Supplementation: Who Needs It? Detail-Document #270102 This Detail-Document accompanies the related article published in PHARMACIST S LETTER / PRESCRIBER S LETTER January 2011 ~ Volume 27 ~ Number 270102 Calcium and Vitamin D Supplementation:

More information

Haemodialysis Blood Results

Haemodialysis Blood Results Haemodialysis Blood Results Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient information leaflets.htm Introduction

More information

Prac%cal Workshop Insulin Ini%a%on. Julie Bate Clinical Nurse Specialist (Diabetes) 26/5/2014

Prac%cal Workshop Insulin Ini%a%on. Julie Bate Clinical Nurse Specialist (Diabetes) 26/5/2014 Prac%cal Workshop Insulin Ini%a%on Julie Bate Clinical Nurse Specialist (Diabetes) 26/5/2014 Establish HbA1c Individual Target Pa%ent educa%on check list: ini%a%on of insulin therapy Self- monitoring of

More information

PROSTATE CANCER. Normal-risk men: No family history of prostate cancer No history of prior screening Not African-American

PROSTATE CANCER. Normal-risk men: No family history of prostate cancer No history of prior screening Not African-American PROSTATE CANCER 1. Guidelines for Screening Risk Factors Normal-risk men: No family history of prostate cancer No history of prior screening Not African-American High-risk men: Family history of prostate

More information