Management of secondary hyperparathyroidism in uremic patients: the role of the new vitamin D analogs.
Secondary hyperparathyroidism - a common comorbid condition in patients with chronic renal insufficiency - is considered a consequence of critical determinants such as hypocalcemia, phosphate retention and reduced levels of calcitriol production. In this complex mechanism, the skeletal apparatus and the nonskeletal targets such as vascular and heart valves are often involved, thus explaining the increased risk of cardiovascular morbidity and mortality of uremic patients. In this review we will focus on the major role played by Calcitriol deficiency as a trigger of secondary hyperparathyroidism and the crucial need for obiquitous vitamin D receptor activation in order to have an optimal PTH control and to obtain a modulation between inhibitors and inducers of soft tissue calcification. This review will also elucidate the possible role of paricalcitol - a new vitamin D analog - in conditioning morbidity and mortality of patients on renal replacement therapy (RRT).
Brancaccio
Diego
D
Chair of Nephrology, University of Milan, Ospedale San Paolo, Milan - Italy. diego.brancaccio@tiscalinet.it
Cozzolino
Mario
M
Galassi
Andrea
A
Chiarelli
Giusy
G
Butti
Alessandra
A
Bellasi
Antonio
A
Rocca-Rey
Lisa
L
Volpi
Angela
A
Anelli
Adriana
A
Zoni
Ulisse
U
Fusaro
Maria
M
Brambilla
Claudia
C
Missaglia
Elena
E
Crovetto
Cesar
C
Russo
Micol
M
Longhini
Carlo
C
Provenzano
Rossana
R
Incalcaterra
Francesca
F
Cerasola
Giovanni
G
Li Vecchi
Maurizio
M
Gallieni
Maurizio
M
D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002117:Calcitriol / Q000172:deficiency / Q000627:therapeutic use; D004872:Ergocalciferols / Q000627:therapeutic use; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology*; D006996:Hypocalcemia / Q000150:complications / Q000188:drug therapy; D010710:Phosphates / Q000378:metabolism; D018167:Receptors, Calcitriol / Q000502:physiology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism; D014511:Uremia / Q000150:complications* / Q000209:etiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy
D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D010710:Phosphates; D018167:Receptors, Calcitriol; D014807:Vitamin D; C084656:paricalcitol; D002117:Calcitriol