Pharmacotherapy of chronic kidney disease and mineral bone disorder.
BACKGROUND
Disturbances of the bone and mineral metabolism are a common complication of chronic kidney disease (CKD); these disturbances are known as CKD-mineral bone disorder (CKD-MBD). A better understanding of the pathophysiological mechanisms of CKD-MBD, along with its negative impact on other organs and systems, as well as on survival, has led to a shift in the treatment paradigm of this disorder. The use of phosphate binders changed dramatically over the last decade when noncalcium-containing phosphate binders, such as sevelamer and lanthanum carbonate, became possible alternative treatments to avoid calcium overload. Vitamin D receptor activators, such as paricalcitol and doxercalciferol, with fewer calcemic and phosphatemic effects, have also been introduced to control parathormone production and the interest in native vitamin D supplementation has grown. Furthermore, a new drug class, the calcimimetics, has recently been introduced into the therapeutic arsenal for treating secondary hyperparathyroidism.


METHODS
This review discusses the advantages and disadvantages of the above pharmacological options to treat CKD-MBD.


CONCLUSIONS
The individual-based use of phosphate binders, vitamin D and calcimimetics, separately or in combination, constitute a reasonable approach to treat CKD-MBD. These treatments aim to achieve a rigorous control of phosphorus and parathormone levels, while avoiding calcium overload.
Universidade de São Paulo, Nephrology Division, Department of Internal Medicine, Av. Dr. Arnaldo, 455, 3rd floor, room 3342, 01246 903, São Paulo, Brazil.
Fellype Carvalho
FC
Barreto
Rodrigo Azevedo
RA
de Oliveira
Rodrigo Bueno
RB
Oliveira
Vanda
V
Jorgetti
D000818:Animals; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000378:metabolism; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy / Q000378:metabolism; D007674:Kidney Diseases / Q000188:drug therapy* / Q000378:metabolism; D010758:Phosphorus / Q000378:metabolism*; D014807:Vitamin D / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D057966:Calcimimetic Agents; D014807:Vitamin D; D010758:Phosphorus