title: Integral pharmacological management of bone mineral disorders in chronic kidney disease (part II): 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) are associated with costly complications and dismal hard-outcomes.
  
  
  METHODS
  In two comprehensive articles we review contemporary and future pharmacological options for treatment of phosphate (P) imbalance (part 1) and hyperparathyroidism (this part 2), taking into account CKD-accelerated cardiovascular calcification (CVC) processes.
  
  
  CONCLUSIONS
  Improvements in CKD-MBD require an integral approach, addressing all three components of the CKD-MBD triad. Here, initial guidance to control hyperparathyroidism is provided, taking into account the presence/absence of CVC. We include also measures for patients at risk of adynamic bone disease or suffering from calciphylaxis. Many epidemiological studies (relating to vitamin D) and thorough analyses of recent randomized clinical trials (of cinacalcet) point towards benefits of attempting to improve biochemical parameters while trying to, at least, avoid progression of CVC by more rational use of intestinal P-binders and low-dose vitamin D derivatives and/or calcimimetics. This approach does not seem to be far away from significantly improving hard-outcomes, at least in the dialysis population. The availability of new drugs and the performance of randomized clinical trials should ultimately lead to define earlier, clearer, and more cost-effective patient stratification and biochemical targets with consequent significant clinical improvements.
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
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: a Department of Nephrology , Fundació Puigvert, IIB Sant Pau, RedinRen , Barcelona , Spain.
authors.forename: S
authors.initials: S
authors.lastname: Mateu
authors.affiliation: c Deartment 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: D001851:Bone Diseases, Metabolic / Q000188:drug therapy*; D000069449:Cinacalcet / Q000627:therapeutic use; D018450:Disease Progression; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy*; D008903:Minerals / Q000378:metabolism; D010710:Phosphates / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D008903:Minerals; D010710:Phosphates; D014807:Vitamin D; D000069449:Cinacalcet
keywords: CKD-MBD; Chronic kidney disease; adynamic bone disease; calcimimetics; calcium receptor; cinacalcet; etelcalcetide; paricalcitol; phosphate; secondary hyperparathyroidism; vascular calcification; vitamin D