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Moderne Behandlungsoptionen des sekundären Hyperparathyreoidismus vor dem Hintergrund kardiovaskulärer Kalzifizierung

Modern treatment options of secondary hyperparathyroidism in the context of cardiovascular calcification

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Zusammenfassung

Der sekundäre Hyperparathyreoidismus (sHPT) hat unbehandelt deletäre Auswirkungen auf verschiedene Organsysteme. Insbesondere die kardiovaskuläre Kalzifizierung als Folge der mit dem sHPT einhergehenden Veränderungen des Knochen- und Mineralstoffwechsels und der zu dessen Therapie eingesetzten medikamentösen Interventionen ist in den Mittelpunkt der Forschung und Behandlungskonzepte gerückt. Sämtliche eingesetzten Therapien sind effektiv im Hinblick auf eine Korrektur der laborchemisch fassbaren Veränderungen im Rahmen des sHPT, aber nur sehr wenige auch klinisch in ihrer Auswirkung auf die kardiovaskuläre Kalzifizierung und patientenbezogene Endpunktdaten (Mortalität, kardiovaskuläre Morbidität) in aussagekräftigen Studien untersucht. Die geringe Anzahl qualitativ hochwertiger randomisierter kontrollierter Studien darf nicht zu einem nihilistischen Ansatz führen. Aufgrund unzureichender Daten ist keine der Therapieoptionen (Phosphatbinder, Substitution mit nativem Vitamin D oder Calcitriol und Analoga, Kalzimimetikum, Parathyreoidektomie) prinzipiell den anderen überlegen, wenn auch patienten- und situationsbezogen Vorteile für die eine oder andere Therapie bestehen. Ein breiteres therapeutisches Fenster verlangt oft eine Kombination dieser Behandlungsoptionen und eine Individualisierung der sHPT-Therapie.

Abstract

Untreated secondary hyperparathyroidism (sHPT) has deleterious effects on various organ systems. In recent years, cardiovascular calcification as a result of sHPT-associated alterations in bone and mineral metabolism and therapeutic interventions used for its treatment has become the focus of research and treatment concepts. All therapies have proven to be effective in terms of correction of the laboratory changes of sHPT, but only very few have also been evaluated clinically in their effect on cardiovascular calcification and patient-related outcome data (mortality, cardiovascular morbidity). Whereas there is only a low number of high-quality randomized controlled trials in the field, this shortcoming should not lead to a nihilistic approach to the relevant clinical problems of patients with sHPT. Nevertheless, because of insufficient clinical data, a single treatment modality, be it phosphorus binders, vitamin D substitution with inactive forms or calcitriol (or vitamin D analogue), calcimimetics, or parathyroidectomy may not claim to be uniformly superior to the others. A wider therapeutic window often prompts the use of a combination of these options and individualization of sHPT management.

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Correspondence to OA PD Dr. Emanuel Zitt.

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Aktualisierung von: Zitt E (2014) Moderne Behandlungsoptionen des sekundären Hyperparathyreoidismus vor dem Hintergrund kardiovaskulärer Kalzifizierung. J Miner Stoffw Muskuloskelet Erkr 21(1):14–19

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Zitt, E. Moderne Behandlungsoptionen des sekundären Hyperparathyreoidismus vor dem Hintergrund kardiovaskulärer Kalzifizierung. J. Miner. Stoffwechs. Muskuloskelet. Erkrank. (2020). https://doi.org/10.1007/s41970-020-00098-7

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Schlüsselwörter

  • Nierenerkrankung
  • CKD-MBD
  • Phosphatbinder
  • Vitamin D
  • Kalzimimetikum

Keywords

  • Kidney disease
  • CKD-MBD
  • Phosphate binder
  • Vitamin D
  • Calcimimetic