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Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s

The situation of secondary hyperparathyroidism (SHPT) in chronic kidney disease patients not on dialysis (ND-CKD) is probably best characterised by the Kidney Disease: Improving Global Outcomes Chronic Kidney Disease–Mineral and Bone Disorder Update 2017 guideline 4.2.1 stating that the optimal para...

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Autores principales: Ketteler, Markus, Bover, Jordi, Mazzaferro, Sandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10229290/
https://www.ncbi.nlm.nih.gov/pubmed/35977397
http://dx.doi.org/10.1093/ndt/gfac236
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author Ketteler, Markus
Bover, Jordi
Mazzaferro, Sandro
author_facet Ketteler, Markus
Bover, Jordi
Mazzaferro, Sandro
author_sort Ketteler, Markus
collection PubMed
description The situation of secondary hyperparathyroidism (SHPT) in chronic kidney disease patients not on dialysis (ND-CKD) is probably best characterised by the Kidney Disease: Improving Global Outcomes Chronic Kidney Disease–Mineral and Bone Disorder Update 2017 guideline 4.2.1 stating that the optimal parathyroid hormone levels are not known in these stages. Furthermore, new caution became recommended with regard to the routine use of active vitamin D analogues in early CKD stages and moderate SHPT phenotypes, due to their potential risks for hypercalcaemia and hyperphosphataemia aggravation. Nevertheless, there is still a substantial clinical need to prevent the development of parathyroid gland autonomy, with its associated consequences of bone and vascular damage, including fracture risks and cardiovascular events. Therefore we now attempt to review the current guideline-based and clinical practice management of SHPT in ND-CKD, including their strengths and weaknesses, favouring individualised approaches respecting calcium and phosphate homeostasis. We further comment on extended-release calcifediol (ERC) as a new differential therapeutic option now also available in Europe and on a potentially novel understanding of a required vitamin D saturation in more advanced CKD stages. There is no doubt, however, that knowledge gaps will remain unless powerful randomised controlled trials with hard and meaningful endpoints are performed.
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spelling pubmed-102292902023-05-31 Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s Ketteler, Markus Bover, Jordi Mazzaferro, Sandro Nephrol Dial Transplant Review The situation of secondary hyperparathyroidism (SHPT) in chronic kidney disease patients not on dialysis (ND-CKD) is probably best characterised by the Kidney Disease: Improving Global Outcomes Chronic Kidney Disease–Mineral and Bone Disorder Update 2017 guideline 4.2.1 stating that the optimal parathyroid hormone levels are not known in these stages. Furthermore, new caution became recommended with regard to the routine use of active vitamin D analogues in early CKD stages and moderate SHPT phenotypes, due to their potential risks for hypercalcaemia and hyperphosphataemia aggravation. Nevertheless, there is still a substantial clinical need to prevent the development of parathyroid gland autonomy, with its associated consequences of bone and vascular damage, including fracture risks and cardiovascular events. Therefore we now attempt to review the current guideline-based and clinical practice management of SHPT in ND-CKD, including their strengths and weaknesses, favouring individualised approaches respecting calcium and phosphate homeostasis. We further comment on extended-release calcifediol (ERC) as a new differential therapeutic option now also available in Europe and on a potentially novel understanding of a required vitamin D saturation in more advanced CKD stages. There is no doubt, however, that knowledge gaps will remain unless powerful randomised controlled trials with hard and meaningful endpoints are performed. Oxford University Press 2022-08-17 /pmc/articles/PMC10229290/ /pubmed/35977397 http://dx.doi.org/10.1093/ndt/gfac236 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Review
Ketteler, Markus
Bover, Jordi
Mazzaferro, Sandro
Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s
title Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s
title_full Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s
title_fullStr Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s
title_full_unstemmed Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s
title_short Treatment of secondary hyperparathyroidism in non-dialysis CKD: an appraisal 2022s
title_sort treatment of secondary hyperparathyroidism in non-dialysis ckd: an appraisal 2022s
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10229290/
https://www.ncbi.nlm.nih.gov/pubmed/35977397
http://dx.doi.org/10.1093/ndt/gfac236
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