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Medical and Surgical Management (Including Diet)

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Clinical Reviews in Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Considerable advances in the understanding and management of CKD–MBD were made in the last years; however, mortality rates remain extremely high, and the optimal approach for preventing and/or treating the mineral bone disorders in patients with stages 3, 4, and 5 CKD remains frustratingly unclear. In an attempt to minimize the morbidity and mortality associated with abnormal mineral metabolism, several evidence-based clinical practice guidelines were published, including the 2009 KDIGO guideline. But, because of the lack of randomized clinical trials, these guidelines were not able to generate strong statements in an area where there is a great unmet medical need for “guidance.” The current paper is a mini review of the current treatment approach of CKD–MBD, which principally involves the administration of some combination of the following: dietary phosphate restriction, phosphate binders (either calcium or non-calcium-containing binders), vitamin D (oral, injectable, or topical into PT glands), calcimimetics, parathyroidectomy/parathyroid ablation with ethanol. However, our management is driven largely by results of observational trials because the number of prospective randomized clinical trials is limited and existing clinical trials often are underpowered or use non-clinical outcomes. Future changes in care should be driven by adequately powered randomized trials with clinical end points.

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References

  1. Goldsmith DJ, Cunningham J. Mineral metabolism, vitamin D in chronic kidney disease–more questions than answers. Nat Rev Nephrol. 2011;7(6):341–6.

    Article  PubMed  CAS  Google Scholar 

  2. Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, Saito A, Rayner HC, Kurokawa K, Port FK, Held PJ, Young EW. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;10:3270–7.

    Article  Google Scholar 

  3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2009;113:S1–130.

    Google Scholar 

  4. Block GA, Klassen PS, Lazarus JM, Ofsthun N, Lowrie EG, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15:2208–18.

    Article  PubMed  CAS  Google Scholar 

  5. Goldsmith D, Covic A, Fouque D, et al. Endorsement of the kidney disease improving global outcomes (KDIGO) chronic kidney disease–mineral and bone disorder (CKD-MBD) guidelines: a european renal best practice (ERBP) commentary statementEndorsement of the kidney disease improving global outcomes (KDIGO) chronic kidney disease–mineral and bone disorder (CKD-MBD) guidelines: a european renal best practice (ERBP) commentary statementerbp. Nephrol Dial Transplant. 2010;25:3823–31.

    Article  PubMed  Google Scholar 

  6. Uhlig K, Berns JS, Kestenbaum B, Kumar R. KDOQI US commentary on the 2009 KDIGO Clinical practice guideline for the diagnosis, evaluation, and treatment of CKD-mineral and bone disorder (CKD-MBD). Am J Kidney Dis. 2010;55(5):773–99.

    Article  PubMed  Google Scholar 

  7. Manns BJ, Hodsman A, Zimmerman DL, et al. Canadian Society of Nephrology commentary on the 2009 KDIGO clinical practice guideline for the diagnosis, evaluation, and treatment of CKD-mineral and bone disorder (CKD-MBD). Am J Kidney Dis. 2010;55(5):800–12.

    Article  PubMed  Google Scholar 

  8. Al Aly Z, Gonzalez EA, Martin KJ, et al. Achieving K/DOQI laboratory target values for bone and mineral metabolism: an uphill battle. Am J Nephrol. 2004;24:422–6.

    Article  PubMed  Google Scholar 

  9. Young EW, Albert JM, Satayathum S, et al. Predictors and consequences of altered mineral metabolism: the dialysis outcomes and practice patterns study. Kidney Int. 2005;67:1179–87.

    Article  PubMed  CAS  Google Scholar 

  10. Wazny LD, Raymond CB, Lesperance EM, et al. Are CSN and NKFK/DOQI mineral metabolism guidelines for hemodialysis patients achievable? Results from a provincial renal program. CANNT J. 2008;18:36–41.

    PubMed  Google Scholar 

  11. Roman-Garcia P, Carrillo-Lopez N, Cannata-Andia JB. Pathogenesis of bone and mineral related disorders in chronic kidney disease: key role of hyperphosphatemia. J Ren Care. 2009;35(Supp 1):34–8.

    Article  PubMed  Google Scholar 

  12. Cozzolino M, Pasho S, Fallabrino G, Olivi L, Gallieni M, Brancaccio D. Pathogenesis of secondary hyperparathyroidism. Int J Artif Organs. 2009;32:75–80.

    PubMed  CAS  Google Scholar 

  13. Wolf M. Fibroblast growth factor 23 and the future of phosphorus management. Curr Opin Nephrol Hypertens. 2009;18:463–8.

    Article  PubMed  CAS  Google Scholar 

  14. Strippoli GF, Craig JC, Schena FP. The number, quality, and coverage of randomized controlled trials in nephrology. J Am Soc Nephrol. 2004;15(2):411–9.

    Article  PubMed  Google Scholar 

  15. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK. Association of elevated serum PO(4), Ca × PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol. 2001;12:2131–8.

    PubMed  CAS  Google Scholar 

  16. Kestenbaum B, Sampson JN, Rudser KD, Patterson DJ, Seliger SL, Young B, Sherrard DJ, Andress DL. Serum phosphate levels and mortality risk among people with chronic kidney disease. J Am Soc Nephrol. 2005;16:520–8.

    Article  PubMed  CAS  Google Scholar 

  17. de Boer IH, Rue TC, Kestenbaum B. Serum phosphorus concentrations in the third National Health and Nutrition Examination Survey (NHANES III). Am J Kidney Dis. 2009;53:399–407.

    Article  PubMed  Google Scholar 

  18. Martin KJ, Gonzalez EA, et al. Prevention and control of phosphate retention/hyperphosphatemia in CKD-MBD: what is normal, when to start, and how to treat? Clin J Am Soc Nephrol. 2011;6:440–6.

    Article  PubMed  Google Scholar 

  19. Moe SM, Sprague SM. Mineral bone disorders in chronic kidney disease. Brenner and Rector’s The Kidney 8th edittion 2008.

  20. Strippoli FM et al. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease a systematic review and meta-analysis. JAMA. 2011; 305(11).

  21. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;2(4):S1–201.

    Google Scholar 

  22. Payne RB. Renal tubular reabsorption of phosphate (TmP/GFR): indications and interpretation. Ann Clin Biochem. 1998;35:201–6.

    PubMed  CAS  Google Scholar 

  23. Block GA, Persky MS, Ketteler M, et al. A randomized double-blind pilot study of serum phosphorus normalization in chronic kidney disease: a new paradigm for clinical outcomes studies in nephrology. Hemodialysis International. 2009;13(3):360–2.

    Article  PubMed  Google Scholar 

  24. de Boer I, Rue TC, Kestenbaum B. Serum phosphorus concentrations in the third national health and nutrition examination survey (NHANES III). Am J Kidney Dis. 2009;53(3):399–407.

    Article  PubMed  Google Scholar 

  25. Navaneethan SD, Palmer SC, Craig JC, et al. Benefits, harms of phosphate binders in CKD: a systematic review of randomized controlled trials. Am J Kidney Dis. 2009;54:619.

    Article  PubMed  CAS  Google Scholar 

  26. Koiwa F, Kazama JJ, Tokumoto A, Onoda N, Kato H, Okada T, Nii-Kono T, Fukagawa M, Shigematsu T. Sevelamer hydrochloride and calcium bicarbonate reduce serum fibroblast growth factor 23 levels in dialysis patients. Ther Apher Dial. 2005;9:336–9.

    Article  PubMed  CAS  Google Scholar 

  27. Oliveira RB, Cancela AL, Graciolli FG, Dos Reis LM, Draibe SA, Cuppari L, Carvalho AB, Jorgetti V, Canziani ME, Moyses RM. Early control of PTH and FGF23 in normophosphatemic CKD patients: A new target in CKD-MBD therapy? Clin J Am Soc Nephrol. 2010;5:286–91.

    Article  PubMed  CAS  Google Scholar 

  28. Langman CB, Cannata-Andia JB. Calcium in chronic kidney disease: Myths and realities. Clin J Am Soc Nephrol. 2010;5:S1–2.

    Article  PubMed  Google Scholar 

  29. de Francisco AL, Leidig M, Covic AC, Ketteler M, Benedyk-Lorens E, Mircescu GM, Scholz C, Ponce P, Passlick-Deetjen J. Evaluation of calcium acetate/magnesium carbonate as a phosphate binder compared with sevelamer hydrochloride in haemodialysis patients: a controlled randomized study (CALMAG study) assessing efficacy and tolerability. Nephrol Dial Transplant. 2010;25(11):3707–17.

    Article  PubMed  Google Scholar 

  30. Chertow GM, Burke SK, Raggi P. Treat to goal working group. Sevelamer attenuates the progression of coronary, aortic calcification in hemodialysis patients. Kidney Int. 2002;62:245.

    Article  PubMed  CAS  Google Scholar 

  31. Sadek T, Mazouz H, Bahloul H, et al. Sevelamer hydrochloride with or without alphacalcidol or higher dialysate calcium vs calcium carbonate in dialysis patients: an open-label, randomized study. Nephrol Dial Transplant. 2003;18:582.

    Article  PubMed  CAS  Google Scholar 

  32. St Peter WL, Liu J, Weinhandl E, Fan Q. A comparison of sevelamer and calcium-based phosphate binders on mortality, hospitalization, and morbidity in hemodialysis: a secondary analysis of the Dialysis Clinical Outcomes Revisited (DCOR) randomized trial using claims data. Am J Kidney Dis. 2008;51:445.

    Article  PubMed  Google Scholar 

  33. Chertow GM, Raggi P, Chasan-Taber S, et al. Determinants of progressive vascular calcification in haemodialysis patients. Nephrol Dial Transplant. 2004;19:1489.

    Article  PubMed  Google Scholar 

  34. Qunibi W, Moustafa M, Muenz LR, He DY, Kessler PD, Diaz-Buxo JA, Budoff M, CARE-2 Investigators. A 1-year randomized trial of calcium acetate versus sevelamer on progression of coronary artery calcification in hemodialysis patients with comparable lipid control: the Calcium Acetate Renagel Evaluation-2 (CARE-2) study. Am J Kidney Dis. 2008;51(6):952.

    Article  PubMed  CAS  Google Scholar 

  35. Caglar K, Ylmaz M, Saglsam M. Short-term treatment with Sevelamer increases serum Fetuin-a concentration and improves endothelial dysfunction in chronic kidney disease stage 4 patients. J Am Soc Nephrol. 2008;3:61–8.

    Article  CAS  Google Scholar 

  36. Block GA, Spiegel DM, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int. 2005;68:1815–24.

    Article  PubMed  CAS  Google Scholar 

  37. Chiang SS, Chen JB, Yang WC. Lanthanum carbonate (Fosrenol) efficacy and tolerability in the treatment of hyperphosphatemic patients with end-stage renal disease. Clin Nephrol. 2005;63:461.

    PubMed  CAS  Google Scholar 

  38. Joy MS, Finn WF. LAM-302 Study Group. Randomized, double-blind, placebo-controlled, dose-titration, phase III study assessing the efficacy, tolerability of lanthanum carbonate: a new phosphate binder for the treatment of hyperphosphatemia. Am J Kidney Dis. 2003;42:96.

    Article  PubMed  CAS  Google Scholar 

  39. Hutchison AJ, Speake M, Al-Baaj F. Reducing high phosphate levels in patients with chronic renal failure undergoing dialysis: a 4-week, dose-finding, open-label study with lanthanum carbonate. Nephrol Dial Transplant. 2004;19:1902.

    Article  PubMed  CAS  Google Scholar 

  40. Finn WF, Joy MS, Hladik G, Lanthanum Study Group. Efficacy, safety of lanthanum carbonate for reduction of serum phosphorus in patients with chronic renal failure receiving hemodialysis. Clin Nephrol. 2004;62:193.

    PubMed  CAS  Google Scholar 

  41. Hutchison AJ, Maes B, Vanwalleghem J, et al. Efficacy, tolerability, and safety of lanthanum carbonate in hyperphosphatemia: a 6-month, randomized, comparative trial versus calcium carbonate. Nephron Clin Pract. 2005.

  42. Shoji T, Kimoto E, Shinohara K, et al. Molecular forms of adiponectin in uraemic plasma. Nephrol Dial Transplant. 2004;19:1937–8.

    Article  PubMed  CAS  Google Scholar 

  43. Naves-Diaz M, Alvarez-Hernández D, Passlick-Deetjen J, et al. Oral active vitamin D is associated with improved survival in hemodialysis patients. Kidney Int. 2008;74:1070–8.

    Article  PubMed  CAS  Google Scholar 

  44. Wolf M. Active vitamin D and survival. J Am Soc Nephrol. 2008;19:1442–3.

    Article  PubMed  Google Scholar 

  45. Goodman WG. The consequences of uncontrolled secondary hyperparathyroidism and its treatment in chronic kidney disease. Semin Dial. 2004;17:209–16.

    Article  PubMed  Google Scholar 

  46. Zitterman A, Schleithoff S, Koerfer R. Vitamin D and vascular calcification. Curr Opin Lipidol. 2007;18:41–6.

    Article  Google Scholar 

  47. Razzaque MS. The dualistic role of vitamin D in vascular calcifications. Kidney Int. 2011;79:708–14.

    Article  PubMed  CAS  Google Scholar 

  48. Tan X, Wen X, Liu Y. Paricalcitol inhibits renal inflammation by promoting vitamin D receptor-mediated sequestration of NF-kappaB signaling. J Am Soc Nephrol. 2008;19:1741–52.

    Article  PubMed  CAS  Google Scholar 

  49. Zhang Z, et al. 1, 25-Dihydroxyvitamin D3 targeting of NF-kappaB suppresses high glucose-induced MCP-1 expression in mesangial cells. Kidney Int. 2007;72:193–201.

    Article  PubMed  CAS  Google Scholar 

  50. Kuhlmann A, et al. 1, 25-Dihydroxyvitamin D3 decreases podocyte loss and podocyte hypertrophy in the subtotally nephrectomized rat. Am J Physiol Renal Physiol. 2004;286:F526–33.

    Article  PubMed  CAS  Google Scholar 

  51. Li YC, et al. 1, 25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin angiotensin system. J Clin Invest. 2002;110:229–38.

    PubMed  CAS  Google Scholar 

  52. Souberbielle JC, Boutten A, Carlier MC, et al. Intermethod variability in PTH measurement: implication for the care of CKD patients. Kidney Int. 2006;70(2):345–50.

    Article  PubMed  CAS  Google Scholar 

  53. Milliner DS, Zinsmeister AR, Lieberman E, Landing B. Soft tissue calcification in pediatric patients with end-stage renal disease. Kidney Int. 1990;38:931.

    Article  PubMed  CAS  Google Scholar 

  54. Goldsmith DJ, Covic A, Sambrook PA, Ackrill P. Vascular calcification in long-term haemodialysis patients in a single unit: a retrospective analysis. Nephron. 1997;77:37.

    Article  PubMed  CAS  Google Scholar 

  55. Teng M, Wolf M, Ofsthun MN, et al. Activated injectable vitamin D, hemodialysis survival: a historical cohort study. J Am Soc Nephrol. 2005;16:1115.

    Article  PubMed  CAS  Google Scholar 

  56. Teng M, Wolf M, Lowrie E, et al. Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med. 2003;349:446.

    Article  PubMed  CAS  Google Scholar 

  57. Shoji T, Shinohara K, Kimoto E, et al. Lower risk for cardiovascular mortality in oral 1alpha-hydroxy vitamin D3 users in a haemodialysis population. Nephrol Dial Transplant. 2004;19:179.

    Article  PubMed  CAS  Google Scholar 

  58. Wolf M, Shah A, Gutierrez O, et al. Vitamin D levels, early mortality among incident hemodialysis patients. Kidney Int. 2007;72:1004.

    Article  PubMed  CAS  Google Scholar 

  59. Kakuta T, Fukagawa M, Fujisaki T, et al. Prognosis of parathyroid function after successful percutaneous ethanol injection therapy guided by color Doppler flow mapping in chronic dialysis patients. Am J Kidney Dis. 1999;33:1091–9.

    Article  PubMed  CAS  Google Scholar 

  60. Shiizaki K, Hatamura I, Negi S, et al. Percutaneous maxacalcitol injection therapy regresses hyperplasia of parathyroid and induces apoptosis in uremia. Kidney Int. 2003;64:992–1003.

    Article  PubMed  CAS  Google Scholar 

  61. Brown AJ, Ritter CS, Finch JL, Slatopolsky EA. Decreased calcium- s-nsing receptor expression in hyperplastic parathyroid glands of uremic rats: Role of dietary phosphate. Kidney Int. 1999;55:1284–92.

    Article  PubMed  CAS  Google Scholar 

  62. Lewin E, Garfia B, Almaden Y, Rodriguez M, Olgaard K. Autoregulation in the parathyroid glands by PTH/PTHrP receptor ligands in normal and uremic rats. Kidney Int. 2003;64:63–70.

    Article  PubMed  CAS  Google Scholar 

  63. Martin KJ, Gonzalez EA, Slatopolsky E: The parathyroids in renal disease: Pathophysiology. In: The Parathyroids: Basic Clinical Concepts, 2nd edn, San Diego, Academic Press Inc., 2001, pp 625–34.

  64. Mizobuchi M, Hatamura I, Ogata H, Saji F, Uda S, Shiizaki K, Sakaguchi T, Negi S, Kinugasa E, Koshikawa S, Akizawa T. Calcimimetic compound upregulates decreased calcium-sensing receptor expression level in parathyroid glands of rats with chronic renal insufficiency. J Am Soc Nephrol. 2004;15:2579–87.

    Article  PubMed  CAS  Google Scholar 

  65. Rodriguez M, Nemeth E, Martin D. The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol. 2005;288:F253–64.

    Article  PubMed  CAS  Google Scholar 

  66. Rodriguez M, Canadillas S, Lopez I, Aguilera-Tejero E, Almaden Y. Regulation of parathyroid function in chronic renal failure. J Bone Miner Metab. 2006;24:164–8.

    Article  PubMed  CAS  Google Scholar 

  67. Mendoza FJ, Lopez I, Canalejo R, Almaden Y, Martin D, Aguilera-Tejero E, Rodriguez M. Direct upregulation of parathyroid calcium-sensing receptor and vitamin D receptor by calcimimetics in uremic rats. Am J Physiol Renal Physiol. 2009;296:F605–13.

    Article  PubMed  CAS  Google Scholar 

  68. Ritter CS, Finch JL, Slatopolsky EA, Brown AJ. Parathyroid hyperplasia in uremic rats precedes down-regulation of the calcium receptor. Kidney Int. 2001;60:1737–44.

    Article  PubMed  CAS  Google Scholar 

  69. Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression and therapeutic options. Clin J Am Soc Nephrol. 2011;6:913–21.

    Article  PubMed  CAS  Google Scholar 

  70. Lopez I, Mendoza FJ, Aguilera-Tejero E, Perez J, Guerrero F, Martin D, Rodriguez M. The effect of calcitriol, paricalcitol, and a calcimimetic on extraosseous calcifications in uremic rats. Kidney Int. 2008;73:300–7.

    Article  PubMed  CAS  Google Scholar 

  71. Rodriguez ME, Almaden Y, Canadillas S, Canalejo A, Siendones E, Lopez I, Aguilera-Tejero E, Martin D, Rodriguez M. The calcimimetic R-568 increases vitamin D receptor expression in rat parathyroid glands. Am J Physiol Renal Physiol. 2007;292:F1390–5.

    Article  PubMed  CAS  Google Scholar 

  72. Nemeth EF, Bennett SA. Tricking the parathyroid gland with novel calcimimetic agents. Nephrol Dial Transplant. 1998;13:1923.

    Article  PubMed  CAS  Google Scholar 

  73. Moe SM, Chertow GM, Coburn JW, et al. Achieving NKF-K/DOQI bone metabolism, disease treatment goals with cinacalcet HCl. Kidney Int. 2005;67:760.

    Article  PubMed  CAS  Google Scholar 

  74. Kramer H, Toto R, Peshock R, et al. Association between chronic kidney disease and coronary artery calcification: the Dallas Heart Study. J Am Soc Nephrol. 2005;16:507–13.

    Article  PubMed  Google Scholar 

  75. Braun J, Oldendorf M, Moshage W, et al. Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis. 1996;27:394–401.

    Article  PubMed  CAS  Google Scholar 

  76. London GM, Guerin AP, Marchais SJ, et al. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2003;18:1731–40.

    Article  PubMed  Google Scholar 

  77. Blacher J, Guerin AP, Pannier B, et al. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001;38:938–42.

    Article  PubMed  CAS  Google Scholar 

  78. Sigrist MK, Taal MW, Bungay P, et al. Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease. Clin J Am Soc Nephrol. 2007;2:1241–8.

    Article  PubMed  CAS  Google Scholar 

  79. Block GA, Raggi P, Bellasi A, et al. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int. 2007;71:438–41.

    Article  PubMed  CAS  Google Scholar 

  80. Chertow GM, Burke SK, Raggi P. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002;62:245–52.

    Article  PubMed  CAS  Google Scholar 

  81. Block GA, Spiegel DM, Ehrlich J, et al. Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int. 2005;68:1815–24.

    Article  PubMed  CAS  Google Scholar 

  82. Asmus HG, Braun J, Krause R, et al. Two year comparison of sevelamer and calcium carbonate effects on cardiovascular calcification and bone density. Nephrol Dial Transplant. 2005;20:1653–61.

    Article  PubMed  CAS  Google Scholar 

  83. Bleyer AJ, Burkart J, Piazza M, et al. Changes in cardiovascular calcification after parathyroidectomy in patients with ESRD. Am J Kidney Dis. 2005;46:464–9.

    Article  PubMed  Google Scholar 

  84. Joki N, Nikolov IG, Caudrillier A, et al. Effects of calcimimetic on vascular calcification and atherosclerosis in uremic mice. Bone. 2009;45:S30–4.

    Article  PubMed  CAS  Google Scholar 

  85. Koleganova N, Piecha G, Ritz E, et al. A calcimimetic (R-568), but not calcitriol, prevents vascular remodeling in uremia. Kidney Int. 2009;75:60–71.

    Article  PubMed  CAS  Google Scholar 

  86. Lopez I, Aguilera-Tejero E, Mendoza FJ, et al. Calcimimetic R-568 decreases extraosseous calcifications in uremic rats treated with calcitriol. J Am Soc Nephrol. 2006;17:795–804.

    Article  PubMed  CAS  Google Scholar 

  87. Raggi P, Chertow G, Torres P, et al. The ADVANCE study: a randomized study to evaluate the effects of cinacalcet plus low-dose vitamin D on vascular calcification in patients on hemodialysis. Nephrol Dial Transplant. 2011;26:1327–39.

    Article  PubMed  CAS  Google Scholar 

  88. Block GA, Zaun D, Smits G, et al. Cinacalcet hydrochloride treatment significantly improves all-cause and cardiovascular survival in a large cohort of hemodialysis patients. Kidney Int. 2010;78(6):578–89.

    Article  PubMed  CAS  Google Scholar 

  89. Chertow GM, Pupim LB, Block GA, et al. Evaluation of cinacalcet therapy to lower cardiovascular events (EVOLVE): rationale and design overview. Clin J Am Soc Nephrol. 2007;2:898–905.

    Article  PubMed  CAS  Google Scholar 

  90. Malluche HH, Monier-Faugere MC, Wang G, et al. An assessment of cinacalcet HCl effects on bone histology in dialysis patients with secondary hyperparathyroidism. Clin Nephrol. 2008;69(4):269–78.

    PubMed  CAS  Google Scholar 

  91. Kestenbaum B, Andress DL, Schwartz SM, et al. Survival following parathyroidectomy among United States dialysis patients. Kidney Int. 2004;66:2010.

    Article  PubMed  Google Scholar 

  92. Chen HH, Lin CJ, Wu CJ, Lai CT, et al. Chemical ablation of recurrent and persistent secondary hyperparathyroidism after subtotal parathyroidectomy. Ann Surg. 2011;253(4):786–90.

    Article  PubMed  Google Scholar 

  93. Douthat WG, Cardozo G, Garay G et al. Use of percutaneous ethanol injection therapy for recurrent secondary hyperparathyroidism after subtotal parathyroidectomy. Int J Neprol. 2011.

  94. Al Aly Z, Gonzalez EA, Martin KJ, et al. Achieving K/DOQI laboratory target values for bone and mineral metabolism: an uphill battle. Am J Nephrol. 2004;24:422–6.

    Article  PubMed  Google Scholar 

  95. Young EW, Albert JM, Satayathum S, et al. Predictors and consequences of altered mineral metabolism: the dialysis outcomes and practice patterns study. Kidney Int. 2005;67:1179–87.

    Article  PubMed  CAS  Google Scholar 

  96. Wazny LD, Raymond CB, Lesperance EM, et al. Are CSN and NKFK/DOQI mineral metabolism guidelines for hemodialysis patients achievable? Results from a provincial renal program. CANNT J. 2008;18:36–41.

    PubMed  Google Scholar 

  97. Block GA, Port F. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis. 2000;35:1226–37.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Nephrology Clinic, Parhon University Hospital, “Gr.T. Popa” University of Medicine and Pharmacy, Carol 1st Blvd. Nr. 50, Iasi, 700503, Romania

    Adrian Covic & Mugurel Apetrii

  2. Renal and Transplantation Unit, Guy’s Hospital, King’s Health Partners AHSC, London, UK

    Eric P. Heymann & David Goldsmith

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  1. Adrian Covic
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Correspondence to Adrian Covic.

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Covic, A., Apetrii, M., Heymann, E.P. et al. Medical and Surgical Management (Including Diet). Clinic Rev Bone Miner Metab 10, 174–183 (2012). https://doi.org/10.1007/s12018-011-9116-4

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