Current issues in the management of secondary hyperparathyroidism and bone disease.
Recent research has demonstrated active bone-like remodelling of vascular tissue in dialysis and non dialysis patients. Cross-sectional studies indicate that the presence of vascular calcification is inversely related to bone mass. Theoretically, the relationship implies that maintaining normal bone turnover and mass may help to decrease vascular calcification. In addition, it is now apparent that phosphorus and the Ca x P product need to be kept as close to normal as possible. Thus, the present goal should be a serum phosphorus of 3.5-5.5 mg/dL, a Ca x P product of <55 mg/dL, and a PTH of around 150-200 pg/mL with the intact assay. Ten years ago, those goals would have been impossible. However, new pharmacologic agents will make their achievement much more realistic.
Moe
S M
SM
Wishard Memorial Hospital, Indiana University School of Medicine, Indianapolis 46202, USA. smoe@iupui.edu
D016723:Bone Remodeling; D002114:Calcinosis / Q000209:etiology / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000378:metabolism; D009131:Muscle, Smooth, Vascular / Q000378:metabolism; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects
D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium