P.B. is a 57-year-old male patient diagnosed with Chronic Kidney Disease (‘CKD’) in January 2019. His past medical history includes Focal Segmental Glomerulosclerosis (‘FSGS’), Type 2 Diabetes Mellitus and Hypertension. P.B.’s renal function progressively deteriorated and reached end-stage renal failure (i.e. G5 CKD) in May 2020. Insertion of Tenckhoff catheter was performed and P.B. commenced on Continuous Ambulatory Peritoneal Dialysis (‘CAPD’) in June 2021.

(a) P.B. would like to understand about the management of hyperphosphatemia in CKD. Describe both the dietary approach and pharmacotherapy as phosphate lowering treatment in CKD. (3 marks)

(b) P.B. discussed with you further that about the onset of a complication so called Secondary Hyperparathyroidism in CKD patients with poor phosphate control. Describe the options of pharmacotherapy in the management of Secondary Hyperparathyroidism in CKD. (4 marks)

(c) Describe the role of erythropoiesis-stimulating agents (‘ESAs’) in the treatment of anemia of CKD. Describe the different types of ESAs and their differences. What are the potential factors in causing ESA-hyporesponsiveness in CKD patients? (5 marks)

(d) Describe on the patient counseling points to be provided by pharmacist on using ESA injections if Darbepoetin injection is newly prescribed for P.B.. (3 marks)