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Calcimimetics in chronic kidney disease: evidence, opportunities and challenges.
Kidney Int. 2008 Aug; 74(3):265-75.KI

Abstract

Secondary hyperparathyroidism (SHPT) remains a highly prevalent and important complication in patients with chronic kidney disease (CKD). Indeed, SHPT may compromise bone health and contribute to the increased cardiovascular risks of these patients. Calcimimetic agents may help to control SHPT and to achieve the stringent mineral metabolism targets in patients with CKD stage 5D. Whether this will translate in improved patient-level outcomes remains to be demonstrated in adequately powered prospective intervention studies. These studies are currently ongoing. Additional investigations are required to define how calcimimetics fit best in the expanding armamentarium to treat SHPT. The role of vitamin D (analogs) and parathyroidectomy needs to be reevaluated in the calcimimetic era. Persistent hyperparathyroidism after successful renal transplantation may also become an important indication for therapy with calcimimetics. In patients with this complication, calcimimetics may help to improve bone health both by suppressing bone turnover and demineralization and may retard or prevent nephrocalcinosis of the graft. The evidence for using calcimimetics in CKD patients not yet on dialysis, conversely, is less straightforward. In these patients, therapy for SHPT should rather be focused on the primary trigger, i.e. the high phosphate load relative to the functional nephron mass.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, University Hospital Leuven, Leuven, Belgium. Pieter.Evenepoel@uz.kuleuven.ac.be

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18528328

Citation

Evenepoel, Pieter. "Calcimimetics in Chronic Kidney Disease: Evidence, Opportunities and Challenges." Kidney International, vol. 74, no. 3, 2008, pp. 265-75.
Evenepoel P. Calcimimetics in chronic kidney disease: evidence, opportunities and challenges. Kidney Int. 2008;74(3):265-75.
Evenepoel, P. (2008). Calcimimetics in chronic kidney disease: evidence, opportunities and challenges. Kidney International, 74(3), 265-75. https://doi.org/10.1038/ki.2008.166
Evenepoel P. Calcimimetics in Chronic Kidney Disease: Evidence, Opportunities and Challenges. Kidney Int. 2008;74(3):265-75. PubMed PMID: 18528328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calcimimetics in chronic kidney disease: evidence, opportunities and challenges. A1 - Evenepoel,Pieter, Y1 - 2008/06/04/ PY - 2008/6/6/pubmed PY - 2008/10/7/medline PY - 2008/6/6/entrez SP - 265 EP - 75 JF - Kidney international JO - Kidney Int VL - 74 IS - 3 N2 - Secondary hyperparathyroidism (SHPT) remains a highly prevalent and important complication in patients with chronic kidney disease (CKD). Indeed, SHPT may compromise bone health and contribute to the increased cardiovascular risks of these patients. Calcimimetic agents may help to control SHPT and to achieve the stringent mineral metabolism targets in patients with CKD stage 5D. Whether this will translate in improved patient-level outcomes remains to be demonstrated in adequately powered prospective intervention studies. These studies are currently ongoing. Additional investigations are required to define how calcimimetics fit best in the expanding armamentarium to treat SHPT. The role of vitamin D (analogs) and parathyroidectomy needs to be reevaluated in the calcimimetic era. Persistent hyperparathyroidism after successful renal transplantation may also become an important indication for therapy with calcimimetics. In patients with this complication, calcimimetics may help to improve bone health both by suppressing bone turnover and demineralization and may retard or prevent nephrocalcinosis of the graft. The evidence for using calcimimetics in CKD patients not yet on dialysis, conversely, is less straightforward. In these patients, therapy for SHPT should rather be focused on the primary trigger, i.e. the high phosphate load relative to the functional nephron mass. SN - 1523-1755 UR - https://www.unboundmedicine.com/medline/citation/18528328/Calcimimetics_in_chronic_kidney_disease:_evidence_opportunities_and_challenges_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)53303-6 DB - PRIME DP - Unbound Medicine ER -