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Management of secondary hyperparathyroidism in the elderly patient with chronic kidney disease.
Drugs Aging. 2009; 26(6):457-68.DA

Abstract

Patients with chronic kidney disease (CKD) are generally affected by secondary hyperparathyroidism (SHPT). High phosphate, low calcium and vitamin D deficiency represent the classical 'triad' involved into the pathogenesis of SHPT in renal insufficiency, in which downregulation of the parathyroid vitamin D receptor and calcium-sensing receptor represents a critical step. Recently, new studies indicate that fibroblast growth factor 23 may play a central role in the regulation of phosphate-vitamin D metabolism in patients with CKD. These new insights into the pathogenesis of SHPT will possibly improve the treatment of this condition in patients with CKD. The 'modern' treatment of SHPT in CKD patients consists of free-calcium and aluminium phosphate binders, vitamin D receptor activators and calcimimetics. However, calcium- and aluminium-based phosphate binders and calcitriol are therapeutic tools that are not without complications, including increasing the risk of cardiovascular calcification in patients with CKD. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients, with particular focus on the elderly, although specific guidelines for control of this disorder in this age group are lacking.

Authors+Show Affiliations

Renal Division, S. Paolo Hospital, University of Milan, Milan, Italy. mariocozzolino@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19591520

Citation

Cozzolino, Mario, et al. "Management of Secondary Hyperparathyroidism in the Elderly Patient With Chronic Kidney Disease." Drugs & Aging, vol. 26, no. 6, 2009, pp. 457-68.
Cozzolino M, Gallieni M, Pasho S, et al. Management of secondary hyperparathyroidism in the elderly patient with chronic kidney disease. Drugs Aging. 2009;26(6):457-68.
Cozzolino, M., Gallieni, M., Pasho, S., Fallabrino, G., Ciceri, P., Volpi, E. M., Olivi, L., & Brancaccio, D. (2009). Management of secondary hyperparathyroidism in the elderly patient with chronic kidney disease. Drugs & Aging, 26(6), 457-68. https://doi.org/10.2165/00002512-200926060-00002
Cozzolino M, et al. Management of Secondary Hyperparathyroidism in the Elderly Patient With Chronic Kidney Disease. Drugs Aging. 2009;26(6):457-68. PubMed PMID: 19591520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of secondary hyperparathyroidism in the elderly patient with chronic kidney disease. AU - Cozzolino,Mario, AU - Gallieni,Maurizio, AU - Pasho,Sabina, AU - Fallabrino,Giuditta, AU - Ciceri,Paola, AU - Volpi,Elisa Maria, AU - Olivi,Laura, AU - Brancaccio,Diego, PY - 2009/7/14/entrez PY - 2009/7/14/pubmed PY - 2009/8/22/medline SP - 457 EP - 68 JF - Drugs & aging JO - Drugs Aging VL - 26 IS - 6 N2 - Patients with chronic kidney disease (CKD) are generally affected by secondary hyperparathyroidism (SHPT). High phosphate, low calcium and vitamin D deficiency represent the classical 'triad' involved into the pathogenesis of SHPT in renal insufficiency, in which downregulation of the parathyroid vitamin D receptor and calcium-sensing receptor represents a critical step. Recently, new studies indicate that fibroblast growth factor 23 may play a central role in the regulation of phosphate-vitamin D metabolism in patients with CKD. These new insights into the pathogenesis of SHPT will possibly improve the treatment of this condition in patients with CKD. The 'modern' treatment of SHPT in CKD patients consists of free-calcium and aluminium phosphate binders, vitamin D receptor activators and calcimimetics. However, calcium- and aluminium-based phosphate binders and calcitriol are therapeutic tools that are not without complications, including increasing the risk of cardiovascular calcification in patients with CKD. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients, with particular focus on the elderly, although specific guidelines for control of this disorder in this age group are lacking. SN - 1170-229X UR - https://www.unboundmedicine.com/medline/citation/19591520/Management_of_secondary_hyperparathyroidism_in_the_elderly_patient_with_chronic_kidney_disease_ L2 - https://dx.doi.org/10.2165/00002512-200926060-00002 DB - PRIME DP - Unbound Medicine ER -