Drugs & Aging

, Volume 26, Issue 6, pp 457–468

Management of Secondary Hyperparathyroidism in the Elderly Patient with Chronic Kidney Disease

  • Mario Cozzolino
  • Maurizio Gallieni
  • Sabina Pasho
  • Giuditta Fallabrino
  • Paola Ciceri
  • Elisa Maria Volpi
  • Laura Olivi
  • Diego Brancaccio
Review Article

DOI: 10.2165/00002512-200926060-00002

Cite this article as:
Cozzolino, M., Gallieni, M., Pasho, S. et al. Drugs Aging (2009) 26: 457. doi:10.2165/00002512-200926060-00002

Abstract

Patients with chronic kidney disease (CKD) are generally affected by secondary hyperparathyroidism (SHPT). High phosphate, low calcium and vitamin D deficiency represent the classical ‘triad’ involved into the pathogenesis of SHPT in renal insufficiency, in which downregulation of the parathyroid vitamin D receptor and calcium-sensing receptor represents a critical step. Recently, new studies indicate that fibroblast growth factor 23 may play a central role in the regulation of phosphate-vitamin D metabolism in patients with CKD.

These new insights into the pathogenesis of SHPT will possibly improve the treatment of this condition in patients with CKD. The ‘modern’ treatment of SHPT in CKD patients consists of free-calcium and aluminium phosphate binders, vitamin D receptor activators and calcimimetics. However, calcium- and aluminium-based phosphate binders and calcitriol are therapeutic tools that are not without complications, including increasing the risk of cardiovascular calcification in patients with CKD. This review summarizes the current understanding and evidence supporting strategies for SHPT treatment in CKD patients, with particular focus on the elderly, although specific guidelines for control of this disorder in this age group are lacking.

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Mario Cozzolino
    • 1
  • Maurizio Gallieni
    • 1
  • Sabina Pasho
    • 1
  • Giuditta Fallabrino
    • 1
  • Paola Ciceri
    • 1
  • Elisa Maria Volpi
    • 1
  • Laura Olivi
    • 1
  • Diego Brancaccio
    • 1
  1. 1.Renal Division, S. Paolo HospitalUniversity of MilanMilanItaly