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Paricalcitol Incident Patient Algorithm, Paricalcitol Established Patient…
Paricalcitol Incident Patient Algorithm
Ca > 9.8
Do not start paricalcitol 2. Monitor Ca monthly
Ca > 10.5
Notify physician for guidance on management
Ca </= 9.8
Give paricalcitol IV 3x/week with HD 2. If >3x/week, space evenly 3x/week. If 1-2x/week, administer with each HD
iPTH (pg/mL)
Tier
Dose
<300
0
0
300-450
1
1
more than 450-600
2
2
more than 600
4
4
Draw net iPTH in one month
Patient new to dialysis 2. Established pt, not received paricalcitol within past 6 mos
Ca >10.2
Redraw Ca in 1 week (maximum 2 draws/month
Paricalcitol Established Patient Algorithm
Ca > 10.1
Hold paricalcitol dose
If most recent Ca <10 & iPTH >300
Restart paricalcitol
PTH bracket
A or B
C or D
restart with the same dose
E
Restart with 1-tier increase
Recheck PTH in 1 month
Hold
Ca > 10.5
Notify physician for guidance on management
Ca </= 10.1
Give paricalcitol IV 3x/week with HD 2. If >3x/week, space evenly 3x/week. If 1-2x/week, administer with each HD
iPTH (pg/mL)
Bracket
<150
A
Hold dose
150-300
B
more than 300-450
C
more than 450-600
D
more than 600
E
1-tier increase
2 more items...
Ca >10.2
Redraw Ca in 1 week (maximum 2 draws/month
Labs
Ca
iPTH
quarterly (Jan, Apr, July, Oct)
monthly (with routine monthly lab draws)
draw with routine monthly lab draws unless otherwise indicated
Tier Dosing
Tier
Dose, mcg
0
1
2
3
4
5
6
7
2 more items...
6
5
4
3
2
1
0
Target: iPTH 150-600 pg/mL, Ca < or = 10.2 mg/dl