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
Por:
Bover, J, Urena-Torres, P, Lloret, MJ, Ruiz, C, daSilva, I, Diaz-Encarnacion, MM, Mercado, C, Mateu, S, Fernandez, E, Ballarin, J
Publicada:
1 ene 2016
Resumen:
Introduction: Chronic kidney disease-mineral and bone disorders (CKD-MBD) are associated with costly complications and dismal hard-outcomes.
Areas covered: 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.
Expert opinion: 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.
Filiaciones:
Bover, J:
Fundacio Puigvert, Dept Nephrol, IIB St Pau, REDinREN, Barcelona, Spain
Urena-Torres, P:
Clin Landy, Dept Nephrol, Ramsay Gen Sante, Paris, France
Univ Paris 05, Dept Renal Physiol, Necker Hosp, Paris, France
Lloret, MJ:
Fundacio Puigvert, Dept Nephrol, IIB St Pau, REDinREN, Barcelona, Spain
Ruiz, C:
Fundacio Puigvert, Dept Nephrol, IIB St Pau, REDinREN, Barcelona, Spain
daSilva, I:
Fundacio Puigvert, Dept Nephrol, IIB St Pau, REDinREN, Barcelona, Spain
Diaz-Encarnacion, MM:
Fundacio Puigvert, Dept Nephrol, IIB St Pau, REDinREN, Barcelona, Spain
Mercado, C:
Fundacio Puigvert, Dept Nephrol, IIB St Pau, REDinREN, Barcelona, Spain
Mateu, S:
Fundacio Puigvert, Dept Nephrol, IIB St Pau, REDinREN, Barcelona, Spain
Fernandez, E:
Hosp Arnau Vilanova, IRB LLeida, RedinRen, Dept Nephrol, Lleida, Spain
Ballarin, J:
Fundacio Puigvert, Dept Nephrol, IIB St Pau, REDinREN, Barcelona, Spain
Green Accepted
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