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General principle | |
(1) Treat hypertension, hyperlipidemia, and hyperglycemia as usual | |
(2) Body weight control | |
(3) Control serum and urine phosphate | |
(4) Avoid hypercalcemia | |
(5) Avoid magnesium, Iron, and L-lysine deficiency | |
(6) Nutritional vitamin-D (NVD) supplement (avoid high dose of VDRAs) | |
(7) Possible fractionated heparin for dialysis | |
(8) AST-120 | |
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Manipulating the complex biology of vascular calcification | |
(1) Pyrophosphate | |
(2) Na thiosulfate | |
(3) Vit-K (especially in warfarin user) | |
(4) Avoid zinc deficiency | |
(5) Avoid excess of vit-E, vit-A, vit-C, and fluoride | |
(6) Antioxidants (?) | |
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Patients with high turnover bone disorder (e.g., hyperparathyroid bone disorder; iPTH > 300 pg/mL + high level BAP) | |
(1) VDRA (paricalcitol/calcitriol) + NVD (cholecalciferol/ergocalciferol) or calcimimetics + NVD | |
(2) Non-metal-containing phosphate binders—sevelamer (for phosphorus) | |
(3) Bisphosphonate + VDRA/NVD (for high PTH + hypercalcemia + low bone mass) | |
(4) Denosumab + VDRA/NVD (for high PTH + hypercalcemia + low bone mass) | |
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Patients with low turnover bone disorder (e.g., adynamic bone disorder; bone alkaline phosphatase < 20 ng/mL, and iPTH < 100 pg/mL) | |
(1) NVD + low dose VDRA | |
(2) Teriparatide | |
(3) Non-metal-containing phosphate binders—sevelamer (for oxidative stress and inflammation) | |
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