title: Management of secondary hyperparathyroidism in the elderly patient with chronic kidney disease.
abstract: Patients with chronic kidney disease (CKD) are generally affected by secondary hyperparathyroidism (SHPT). High phosphate, low calcium and vitamin D deficiency represent the classical 'triad' involved into the pathogenesis of SHPT in renal insufficiency, in which downregulation of the parathyroid vitamin D receptor and calcium-sensing receptor represents a critical step. Recently, new studies indicate that fibroblast growth factor 23 may play a central role in the regulation of phosphate-vitamin D metabolism in patients with CKD. These new insights into the pathogenesis of SHPT will possibly improve the treatment of this condition in patients with CKD. The 'modern' treatment of SHPT in CKD patients consists of free-calcium and aluminium phosphate binders, vitamin D receptor activators and calcimimetics. However, calcium- and aluminium-based phosphate binders and calcitriol are therapeutic tools that are not without complications, including increasing the risk of cardiovascular calcification in patients with CKD. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients, with particular focus on the elderly, although specific guidelines for control of this disorder in this age group are lacking.
authors: Renal Division, S. Paolo Hospital, University of Milan, Milan, Italy. mariocozzolino@hotmail.com
authors: Mario
authors: M
authors: Cozzolino
authors: Maurizio
authors: M
authors: Gallieni
authors: Sabina
authors: S
authors: Pasho
authors: Giuditta
authors: G
authors: Fallabrino
authors: Paola
authors: P
authors: Ciceri
authors: Elisa Maria
authors: EM
authors: Volpi
authors: Laura
authors: L
authors: Olivi
authors: Diego
authors: D
authors: Brancaccio
mesh_terms: D000368:Aged; D002614:Chelating Agents / Q000627:therapeutic use*; D000069449:Cinacalcet; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery / Q000628:therapy; D009281:Naphthalenes / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010710:Phosphates / Q000378:metabolism; D017410:Practice Guidelines as Topic; D018167:Receptors, Calcitriol / Q000819:agonists; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy
chemical_list: D002614:Chelating Agents; D009281:Naphthalenes; D010281:Parathyroid Hormone; D010710:Phosphates; D018167:Receptors, Calcitriol; D000069449:Cinacalcet