What factors contribute to hypocalcemia in CKD?
• Hyperphosphatemia
• Decreased levels of 1,25D
• Decreased kidney mass as kidney disease progresses
• Accumulation of bone-derived hormone fibroblast growth factor 23 (FGF-23). FGF-23 reduces the activity of the 1-hydroxylase enzyme in the kidney.
• Skeletal resistance to the calcemic action of PTH.
