Phos binder dual therapy...

[WVUPharm2007]

...can anybody give me a non-crackpot reason why the local nephrologist is going around prescribing dual PhosLo and Renagel therapy for his ESRD patients?

Normally, I wouldn't care, but I have to deal with this annoying thing called "medication reconciliation" that unfortunately makes me care. It's a fabulous concept where, time after time, I get to tell random physicians how idiotic their outpatient drug therapy is...upon which I am then brushed away like a fly over the phone as they wallow away in the comforting fact that they can just ignore me and continue practicing medicine away from common guidelines.

Anyway, I could see if maybe the physician gave them both and had them switch off based upon serum phos/ca++ levels or something crazy-unnecessary like that, but both at the same time?

So these people will come in with acute renal problems, the attendings will come in, order both meds because "it's what they take at home" (instantly forcing me to intervene against my will...lol), upon which I note that the Ca++ is like 11.8 or something ridiculously too high for PhosLo therapy...only to note that they've neglected to order a phos level in the 28 hours it took them to piece together said med rec form. I call them, they curse at me for a few minutes for wasting their time on something as mundane as a situation that has been proven to increase mortality rates in people. Then, after not just going away like most passive-aggressive pharmacists, they just tell me to D/C it and consult renal...upon which OUR nephrologist does it up right...puts them on just Renagel...and all is well and good.

But ANYWAY...all of this wasted time stems from a renal doc somewhere in W. PA that is prescribing both at the same time. Somebody PLEASE tell me there is some obscure study out of freakin' Lichtenstein or something that promotes the benefit of using both agents concurrently...because if I have to endure this song and dance one more time for no reason, I may very well go insane. Well...more insane, anyway...

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[ItsOverZyvox]

It's common. I haven't read studies on dual therapy but more often than not, nephrologists will add the 2nd agent when hyperphosphatemia isn't fully controlled per KDOQI guideline. I haven't read the Ca/PO4 section that carefully so I recommend you read that section of the KDOQI guideline which you should be able to find. It might give you a reference to the dual therapy.

One of the goals is to reduce vascular calcification in these patients.

 

[WVUPharm2007]

It's common. I haven't read studies on dual therapy but more often than not, nephrologists will add the 2nd agent when hyperphosphatemia isn't fully controlled per KDOQI guideline. I haven't read the Ca/PO4 section that carefully so I recommend you read that section of the KDOQI guideline which you should be able to find. It might give you a reference to the dual therapy.

One of the goals is to reduce vascular calcification in these patients.

Nope, not in there.