Tags

Type your tag names separated by a space and hit enter

Integral pharmacological management of bone mineral disorders in chronic kidney disease (part I): from treatment of phosphate imbalance to control of PTH and prevention of progression of cardiovascular calcification.
Expert Opin Pharmacother. 2016 Jun; 17(9):1247-58.EO

Abstract

INTRODUCTION

Chronic kidney disease-mineral and bone disorders (CKD-MBD), involving a triad of laboratory and bone abnormalities, and tissue calcifications, are associated with dismal hard-outcomes.

AREAS COVERED

In two comprehensive articles, we review contemporary and future pharmacological options for treatment of phosphate (P) imbalance (this part 1) and hyperparathyroidism (part 2), taking into account CKD-accelerated atheromatosis/atherosclerosis and/or cardiovascular calcification (CVC) processes.

EXPERT OPINION

Improvements in CKD-MBD require an integral approach, addressing all three components of the CKD-MBD triad. Individualization of treatment with P-binders and combinations of anti-parathyroid agents may improve biochemical control with lower incidence of undesirable effects. Isolated biochemical parameters do not accurately reflect calcium or P load or bone activity and do not stratify high cardiovascular risk patients with CKD. Initial guidance is provided on reasonable therapeutic strategies which consider the presence of CVC. This part reflects that although there is not an absolute evidence, many studies point to the need to improve P imbalance while trying to, at least, avoid progression of CVC by restriction of Ca-based P-binders if economically feasible. The availability of new drugs (i.e. inhibitors of intestinal transporters), and studies including early CKD should ultimately lead to clearer and more cost/effective clinical targets for CKD-MBD.

Authors+Show Affiliations

a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.b Department of Nephrology, Ramsay-Genérale de Santé, Clinique du Landy and Department of Renal Physiology , Necker Hospital, University of Paris Descartes , Paris , France.a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.c Department of Nephrology , Hospital Universitari Arnau de Vilanova, IRB LLeida, RedinRen , Lleida , Spain.c Department of Nephrology , Hospital Universitari Arnau de Vilanova, IRB LLeida, RedinRen , Lleida , Spain.a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27156993

Citation

Bover, J, et al. "Integral Pharmacological Management of Bone Mineral Disorders in Chronic Kidney Disease (part I): From Treatment of Phosphate Imbalance to Control of PTH and Prevention of Progression of Cardiovascular Calcification." Expert Opinion On Pharmacotherapy, vol. 17, no. 9, 2016, pp. 1247-58.
Bover J, Ureña-Torres P, Lloret MJ, et al. Integral pharmacological management of bone mineral disorders in chronic kidney disease (part I): from treatment of phosphate imbalance to control of PTH and prevention of progression of cardiovascular calcification. Expert Opin Pharmacother. 2016;17(9):1247-58.
Bover, J., Ureña-Torres, P., Lloret, M. J., Ruiz-García, C., DaSilva, I., Diaz-Encarnacion, M. M., Mercado, C., Mateu, S., Fernández, E., & Ballarin, J. (2016). Integral pharmacological management of bone mineral disorders in chronic kidney disease (part I): from treatment of phosphate imbalance to control of PTH and prevention of progression of cardiovascular calcification. Expert Opinion On Pharmacotherapy, 17(9), 1247-58. https://doi.org/10.1080/14656566.2016.1182155
Bover J, et al. Integral Pharmacological Management of Bone Mineral Disorders in Chronic Kidney Disease (part I): From Treatment of Phosphate Imbalance to Control of PTH and Prevention of Progression of Cardiovascular Calcification. Expert Opin Pharmacother. 2016;17(9):1247-58. PubMed PMID: 27156993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Integral pharmacological management of bone mineral disorders in chronic kidney disease (part I): from treatment of phosphate imbalance to control of PTH and prevention of progression of cardiovascular calcification. AU - Bover,J, AU - Ureña-Torres,P, AU - Lloret,M J, AU - Ruiz-García,C, AU - DaSilva,I, AU - Diaz-Encarnacion,M M, AU - Mercado,C, AU - Mateu,S, AU - Fernández,E, AU - Ballarin,J, Y1 - 2016/05/13/ PY - 2016/5/10/entrez PY - 2016/5/10/pubmed PY - 2017/3/4/medline KW - CKD-MBD KW - Chronic kidney disease KW - calcium receptor KW - hyperparathyroidism KW - iron KW - phosphate KW - phosphate binders KW - vascular calcification KW - vitamin D SP - 1247 EP - 58 JF - Expert opinion on pharmacotherapy JO - Expert Opin Pharmacother VL - 17 IS - 9 N2 - INTRODUCTION: Chronic kidney disease-mineral and bone disorders (CKD-MBD), involving a triad of laboratory and bone abnormalities, and tissue calcifications, are associated with dismal hard-outcomes. AREAS COVERED: In two comprehensive articles, we review contemporary and future pharmacological options for treatment of phosphate (P) imbalance (this part 1) and hyperparathyroidism (part 2), taking into account CKD-accelerated atheromatosis/atherosclerosis and/or cardiovascular calcification (CVC) processes. EXPERT OPINION: Improvements in CKD-MBD require an integral approach, addressing all three components of the CKD-MBD triad. Individualization of treatment with P-binders and combinations of anti-parathyroid agents may improve biochemical control with lower incidence of undesirable effects. Isolated biochemical parameters do not accurately reflect calcium or P load or bone activity and do not stratify high cardiovascular risk patients with CKD. Initial guidance is provided on reasonable therapeutic strategies which consider the presence of CVC. This part reflects that although there is not an absolute evidence, many studies point to the need to improve P imbalance while trying to, at least, avoid progression of CVC by restriction of Ca-based P-binders if economically feasible. The availability of new drugs (i.e. inhibitors of intestinal transporters), and studies including early CKD should ultimately lead to clearer and more cost/effective clinical targets for CKD-MBD. SN - 1744-7666 UR - https://www.unboundmedicine.com/medline/citation/27156993/Integral_pharmacological_management_of_bone_mineral_disorders_in_chronic_kidney_disease__part_I_:_from_treatment_of_phosphate_imbalance_to_control_of_PTH_and_prevention_of_progression_of_cardiovascular_calcification_ L2 - https://www.tandfonline.com/doi/full/10.1080/14656566.2016.1182155 DB - PRIME DP - Unbound Medicine ER -