[New therapy strategies in secondary hyperparathyroidism on dialysis (I): new concepts, new treatments].
Secondary hyperparathyroidism (SHP) is still an early and frequent complication of chronic renal disease (CRD). Currently, CRD is an independent cardiovascular risk factor, and calcium-phosphorus metabolism is one of the modifiable related factors. In this first article, we summarize the recent SHP treatment paradigm shift in dialysis patients, derived from the better knowledge and understanding of vascular calcification. We analyze the most recent guidelines (K/DOQI), and describe the general implications of hyperphosphatemia, as well as our therapeutic approach with phosphorus-binders. Since sevelamer additionally presents some pleiotropic effects and it attenuates the progression of vascular calcification, we consider it in the first-line of treatment despite it is not yet demonstrated a survival benefit. We also minimize the use of elemental calcium to a maximum of 1000 to 1500 mg/day. Lanthanum carbonate may well be an important therapeutic agent in the near future, especially if security concerns related to metal accumulation are overcome. Ferric citrate, colestilan and nicotinamide may soon play a role. All these drugs, isolated or in combination, are important in the treatment of SHP since a great deal of its success and the avoidance of some dialysis-related complications depend on an efficient phosphorus control.
Bover
J
J
Fundació Puigvert, Universidad Autónoma de Barcelona UAB, Barcelona.
Ortiz-Herbener
F
F
Ballarín
J
J
Andrés
E
E
Barceló
P
P
D000465:Algorithms; D001647:Bile Acids and Salts / Q000008:administration & dosage / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004852:Epoxy Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007811:Lanthanum / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D009536:Niacinamide / Q000008:administration & dosage / Q000627:therapeutic use; D028044:Phosphate-Binding Proteins / Q000627:therapeutic use; D010710:Phosphates / Q000097:blood / Q000378:metabolism; D010758:Phosphorus / Q000378:metabolism; D011073:Polyamines; D011095:Polyethylenes / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D000069603:Sevelamer; D013997:Time Factors
D001647:Bile Acids and Salts; D004852:Epoxy Compounds; D005290:Ferric Compounds; D028044:Phosphate-Binding Proteins; D010710:Phosphates; D011073:Polyamines; D011095:Polyethylenes; D009536:Niacinamide; D010758:Phosphorus; C025314:ferric citrate; D007811:Lanthanum; D000069603:Sevelamer; D002118:Calcium; C106574:cholebine