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01.06.2009 | Review Article

Management of Secondary Hyperparathyroidism in the Elderly Patient with Chronic Kidney Disease

verfasst von: Dr Mario Cozzolino, Maurizio Gallieni, Sabina Pasho, Giuditta Fallabrino, Paola Ciceri, Elisa Maria Volpi, Laura Olivi, Diego Brancaccio

Erschienen in: Drugs & Aging | Ausgabe 6/2009

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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.

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Titel: Management of Secondary Hyperparathyroidism in the Elderly Patient with Chronic Kidney Disease
verfasst von: Dr Mario Cozzolino
Maurizio Gallieni
Sabina Pasho
Giuditta Fallabrino
Paola Ciceri
Elisa Maria Volpi
Laura Olivi
Diego Brancaccio
Publikationsdatum: 01.06.2009
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 6/2009
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.2165/00002512-200926060-00002

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