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Management of Secondary Hyperparathyroidism in Chronic Kidney Disease: A Focus on the Elderly

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Abstract

Secondary hyperparathyroidism (SHPT) is a major complication of chronic kidney disease (CKD), responsible for skeletal and vascular damage with increased risk of bone fractures, cardiovascular events, and mortality. However, the optimal serum parathormone (PTH) levels for improving clinical outcomes remain uncertain. Treatment of SHPT is based on nutritional therapy, phosphate binders, vitamin D, and calcimimetics, but none of these interventions has ever been tested against placebo in randomized controlled trials. Treatment of SHPT in the elderly should consider the many peculiarities of aging in terms of physiopathology, quality of life, symptoms, subjective perception of disease, drug load, and the modifying effect of treatment on disease-related outcomes. Unfortunately, peculiarities of SHPT among elderly CKD patients are mainly unexplored. The present review aims to provide a reasonable merging of evidence regarding the management of SHPT in CKD, with more actual concepts on how to care for older patients.

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Authors and Affiliations

  1. Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, S. Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy

    Andrea Galassi, Eliana Fasulo & Mario Cozzolino

  2. Renal Research Laboratory, Department of Nephrology, Dialysis and Renal Transplant, Fondazione Ca’ Granda IRCCS, Ospedale Maggiore Policlinico, Milan, Italy

    Paola Ciceri

  3. Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy

    Stefano Carugo

  4. Nephrology Dialysis and Renal Transplant Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola Hospital, University of Bologna, Bologna, Italy

    Giuseppe Cianciolo

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  1. Andrea Galassi
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Galassi, A., Ciceri, P., Fasulo, E. et al. Management of Secondary Hyperparathyroidism in Chronic Kidney Disease: A Focus on the Elderly. Drugs Aging 36, 885–895 (2019). https://doi.org/10.1007/s40266-019-00696-3

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