title: Integral pharmacological management of bone mineral disorders in chronic kidney disease (part I): from treatment of phosphate imbalance to control of PTH and prevention of progression of cardiovascular calcification.
abstract: BACKGROUND
  Chronic kidney disease-mineral and bone disorders (CKD-MBD), involving a triad of laboratory and bone abnormalities, and tissue calcifications, are associated with dismal hard-outcomes.
  
  
  METHODS
  In two comprehensive articles, we review contemporary and future pharmacological options for treatment of phosphate (P) imbalance (this part 1) and hyperparathyroidism (part 2), taking into account CKD-accelerated atheromatosis/atherosclerosis and/or cardiovascular calcification (CVC) processes.
  
  
  CONCLUSIONS
  Improvements in CKD-MBD require an integral approach, addressing all three components of the CKD-MBD triad. Individualization of treatment with P-binders and combinations of anti-parathyroid agents may improve biochemical control with lower incidence of undesirable effects. Isolated biochemical parameters do not accurately reflect calcium or P load or bone activity and do not stratify high cardiovascular risk patients with CKD. Initial guidance is provided on reasonable therapeutic strategies which consider the presence of CVC. This part reflects that although there is not an absolute evidence, many studies point to the need to improve P imbalance while trying to, at least, avoid progression of CVC by restriction of Ca-based P-binders if economically feasible. The availability of new drugs (i.e. inhibitors of intestinal transporters), and studies including early CKD should ultimately lead to clearer and more cost/effective clinical targets for CKD-MBD.
authors.affiliation: a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bover
authors.affiliation: b Department of Nephrology, Ramsay-Genérale de Santé, Clinique du Landy and Department of Renal Physiology , Necker Hospital, University of Paris Descartes , Paris , France.
authors.forename: P
authors.initials: P
authors.lastname: Ureña-Torres
authors.affiliation: a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Lloret
authors.affiliation: a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.
authors.forename: C
authors.initials: C
authors.lastname: Ruiz-García
authors.affiliation: a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.
authors.forename: I
authors.initials: I
authors.lastname: DaSilva
authors.affiliation: a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.
authors.forename: M M
authors.initials: MM
authors.lastname: Diaz-Encarnacion
authors.affiliation: a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.
authors.forename: C
authors.initials: C
authors.lastname: Mercado
authors.affiliation: c Department of Nephrology , Hospital Universitari Arnau de Vilanova, IRB LLeida, RedinRen , Lleida , Spain.
authors.forename: S
authors.initials: S
authors.lastname: Mateu
authors.affiliation: c Department of Nephrology , Hospital Universitari Arnau de Vilanova, IRB LLeida, RedinRen , Lleida , Spain.
authors.forename: E
authors.initials: E
authors.lastname: Fernández
authors.affiliation: a Department of Nephrology, Fundació Puigvert , IIB Sant Pau, RedinRen , Barcelona , Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ballarin
mesh_terms: D001847:Bone Diseases / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D057966:Calcimimetic Agents / Q000627:therapeutic use; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications / Q000378:metabolism / Q000517:prevention & control*; D018450:Disease Progression; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D008903:Minerals / Q000378:metabolism; D010281:Parathyroid Hormone / Q000378:metabolism; D010710:Phosphates / Q000172:deficiency / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D012307:Risk Factors; D061205:Vascular Calcification / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D057966:Calcimimetic Agents; D008903:Minerals; D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium
keywords: CKD-MBD; Chronic kidney disease; calcium receptor; hyperparathyroidism; iron; phosphate; phosphate binders; vascular calcification; vitamin D