Do you stop activated vitamin D (ie paricalcitol) in your dialysis patients who have hyperphosphatemia despite low phosphate diet and phosphorus binder adherence?

I usually don't unless their phosphorus is very high (>8) or if they are on very high doses of Vitamin D analogues, in which case, I trial a lower dose. In general, I don't think Vitamin D analogues contribute that much to higher phosphorus levels. Of course, if the phosphorus and PTH are both high ...