New strategies in treatment of mineral and bone disorders and associated cardiovascular disease in patients with chronic kidney disease.
Mineral and bone disorders in chronic kidney disease (CKD) patients along with the use of calcium-based phosphate binders may result in vascular calcification (VC) development and associated increase in cardiovascular diseases (CVD) mortality. A few treatment modalities to control hyperphosphatemia, VC and CVD over the years have failed. Recently appeared calcium-aluminum free phosphate binders (sevelamer hydrochloride and lanthanum carbonate) have reduced hypercalcemic adverse events compared to calcium-based binders, although beneficial effects on CVD outcome to justify further widespread utilization of these agents in CKD patients are not reported so far. At present long-term safety of lanthanum administration has been challenged based on its similarities with aluminum and associated liver toxicity reported in experimental rat models. However, recent evidence in CKD patients and the absence of solid arguments for any particular rat organ toxicity, suggest that lanthanum is safe and efficient in treatment of hyperphosphatemia. Classical interventions aimed to reduce PTH concentration are associated with an increase in Ca x P product. A major breakthrough here was achieved with introduction of calcimimetics (cinacalcet). Apart from its effectiveness in reduction of PTH and Ca x P product, a lot of controversy appeared on the cost-effectiveness of this drug in absence of CVD outcome evidence. Hence, adoption of these new therapeutical strategies might be reserved for adamantine cases when there is no economical constraint for this long-term treatment. In this regard, new therapeutic strategies and patents in CKD patients will be discussed in this review.
Spasovski
Goce
G
Department of Nephrology, Medical Faculty, University of Skopje, Vodnjanska 17, 1000 Skopje, R. Macedonia. gspas@sonet.com.mk
D002114:Calcinosis / Q000401:mortality / Q000628:therapy; D002318:Cardiovascular Diseases / Q000401:mortality / Q000628:therapy*; D002908:Chronic Disease; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D007811:Lanthanum / Q000627:therapeutic use; D008903:Minerals / Q000378:metabolism*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000378:metabolism; D011073:Polyamines / Q000627:therapeutic use; D000069603:Sevelamer
D008903:Minerals; D010281:Parathyroid Hormone; D010710:Phosphates; D011073:Polyamines; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer