End-stage Kidney Disease From in Medicine / Internal Medicine — 45yo Woman | Nephrology | SMLE Q#12328
SMLE Question #12328
Medicine / Internal Medicine
Nephrology
Objective: OBJ-188
Last updated: February 2026
A 45-year-old woman with end-stage kidney disease from type 1 diabetes mellitus attends routine follow-up. She has been on thrice-weekly hemodialysis for 2 years and is intermittently adherent to phosphate binders. She denies bone pain, pruritus, or muscle weakness. Examination is unremarkable. Laboratory tests show hypocalcaemia, hyperphosphataemia, markedly elevated parathyroid hormone, and low 1,25-dihydroxyvitamin D. What is the most appropriate next step in management?
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