Current Understanding of Mineral and Bone Disorders of Chronic Kidney Disease and the Scientific Grounds on the Use of Exogenous Parathyroid Hormone in Its Management
Journal of Bone Metabolism
;
: 1-13, 2020.
Artigo
em Inglês
| WPRIM
| ID: wpr-811189
ABSTRACT
Chronic Kidney disease (CKD) disturbs mineral homeostasis leading to mineral and bone disorders (MBD). Serum calcium and phosphate (Pi) remain normal until the late stages of CKD at the expense of elevate fibroblast growth factor-23 (FGF-23), a phosphaturic hormone, followed by reduced 1,25-dihydroxy-vitamin D (1,25[OH]2D) and finally elevated parathyroid hormone (PTH). Pi retention is thought to be the initial cause of CKD-MBD. The management of MBD is a huge clinical challenge because the effectiveness of current therapeutic regimens to prevent and treat MBD is limited. An intermittent regimen of PTH, when administered at the early stages of CKD, through its phosphaturic action, could prevent FGF-23 increases, the drop of 1,25(OH)2D, and the development of renal osteodystrophy, including secondary hyperparathyroidism (HPT) and its catabolic effects on the skeleton. Even in more advanced stages of CKD that have not progressed to tertiary HPT, could be beneficial. Therapeutic effects could be achieved in vascular calcification as well. Limited experimental/clinical data support the effectiveness of PTH in CKD-MBD. Its safety, has been established only when it is used for the treatment of osteoporosis, including patients with CKD. The proposed intermittent PTH administration is biologically plausible but its effectiveness and safety has to be critically assessed in long term prospective studies in patients with CKD-MBD.
Texto completo:
DisponíveL
Índice:
WPRIM (Pacífico Ocidental)
Assunto principal:
Osteoporose
/
Hormônio Paratireóideo
/
Distúrbio Mineral e Ósseo na Doença Renal Crônica
/
Esqueleto
/
Cálcio
/
Estudos Prospectivos
/
Usos Terapêuticos
/
Insuficiência Renal Crônica
/
Calcificação Vascular
/
Fibroblastos
Tipo de estudo:
Estudo observacional
Limite:
Humanos
Idioma:
Inglês
Revista:
Journal of Bone Metabolism
Ano de publicação:
2020
Tipo de documento:
Artigo
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