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

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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.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. Mario Cozzolino has received honoraria from Shire, Abbott, Amgen, Genzyme and Roche. Maurizio Gallieni has received honoraria from Genzyme and Amgen. Diego Brancaccio has received honoraria from Abbott, Shire and Amgen. The other authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Renal Division, S. Paolo Hospital, University of Milan, Via A. di Rudiní, 8-20142, Milan, Italy

    Mario Cozzolino, Maurizio Gallieni, Sabina Pasho, Giuditta Fallabrino, Paola Ciceri, Elisa Maria Volpi, Laura Olivi & Diego Brancaccio

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  1. Mario Cozzolino
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Cozzolino, M., Gallieni, M., Pasho, S. et al. Management of Secondary Hyperparathyroidism in the Elderly Patient with Chronic Kidney Disease. Drugs Aging 26, 457–468 (2009). https://doi.org/10.2165/00002512-200926060-00002

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