title: Preventive measures and new pharmacological approaches of calcium and phosphate disorders.
abstract: Abnormalities of bone mineral parameters (calcium, phosphate, vitamin D, and parathyroid hormone) are nearly omnipresent in patients with advanced chronic kidney disease (CKD). These typically consist of hypocalcemia, hyperphosphatemia, abnormalities of vitamin D metabolism, and secondary hyperparathyroidism (SHPT). Currently, several lines of evidence suggest that these abnormalities may have consequences beyond the typical consequence of renal bone disease, with a major role in determining cardiovascular disease, including arterial calcification. The 'classical' treatment of SHPT and hyperphosphatemia in HD patients consists of phosphate binders, vitamin D receptor activators (VDRAs), and/or calcimimetics. Calcium- or aluminum-based phosphate binder prescriptions and calcitriol administration are therapeutic tools not free of complications, increasing the risk of cardiovascular calcification in the HD population. New calcium- and aluminum-free phosphate binders, such as lanthanum carbonate and sevelamer hydrochloride, new VDRA (paricalcitol), and cinacalcet hydrochloride can be used to treat SHPT, slow down the atherosclerotic process, and prevent vascular calcification in HD patients.
authors.affiliation: Chair and Division of Nephrology, University of Milan, S. Paolo Hospital, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Andrea
authors.initials: A
authors.lastname: Galassi
authors.forename: Sabina
authors.initials: S
authors.lastname: Pasho
authors.forename: Guditta
authors.initials: G
authors.lastname: Fallabrino
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.forename: Diego
authors.initials: D
authors.lastname: Brancaccio
mesh_terms: D002118:Calcium / Q000378:metabolism*; D002908:Chronic Disease; D000069449:Cinacalcet; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000517:prevention & control*; D007674:Kidney Diseases / Q000150:complications / Q000378:metabolism; D007811:Lanthanum / Q000627:therapeutic use; D009281:Naphthalenes / Q000627:therapeutic use; D010710:Phosphates / Q000378:metabolism*; D011073:Polyamines / Q000627:therapeutic use; D006435:Renal Dialysis; D000069603:Sevelamer; D014807:Vitamin D / Q000378:metabolism*
chemical_list: D009281:Naphthalenes; D010710:Phosphates; D011073:Polyamines; D014807:Vitamin D; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer; D002118:Calcium; D000069449:Cinacalcet