title: Management of secondary hyperparathyroidism in uremic patients: the role of the new vitamin D analogs.
abstract: 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).
authors.affiliation: Chair of Nephrology, University of Milan, Ospedale San Paolo, Milan - Italy. diego.brancaccio@tiscalinet.it
authors.forename: Diego
authors.initials: D
authors.lastname: Brancaccio
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Andrea
authors.initials: A
authors.lastname: Galassi
authors.forename: Giusy
authors.initials: G
authors.lastname: Chiarelli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Butti
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellasi
authors.forename: Lisa
authors.initials: L
authors.lastname: Rocca-Rey
authors.forename: Angela
authors.initials: A
authors.lastname: Volpi
authors.forename: Adriana
authors.initials: A
authors.lastname: Anelli
authors.forename: Ulisse
authors.initials: U
authors.lastname: Zoni
authors.forename: Maria
authors.initials: M
authors.lastname: Fusaro
authors.forename: Claudia
authors.initials: C
authors.lastname: Brambilla
authors.forename: Elena
authors.initials: E
authors.lastname: Missaglia
authors.forename: Cesar
authors.initials: C
authors.lastname: Crovetto
authors.forename: Micol
authors.initials: M
authors.lastname: Russo
authors.forename: Carlo
authors.initials: C
authors.lastname: Longhini
authors.forename: Rossana
authors.initials: R
authors.lastname: Provenzano
authors.forename: Francesca
authors.initials: F
authors.lastname: Incalcaterra
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cerasola
authors.forename: Maurizio
authors.initials: M
authors.lastname: Li Vecchi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
mesh_terms: 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
chemical_list: D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D010710:Phosphates; D018167:Receptors, Calcitriol; D014807:Vitamin D; C084656:paricalcitol; D002117:Calcitriol