Introduction: Secondary hyperparathyroidism (SHPT) represents a complication of chronic kidney disease (CKD). Vitamin D system is altered since early CKD, and vitamin D deficiency is an established trigger of SHPT. Although untreated SHPT may degenerate into tertiary hyperparathyroidism with detrimental consequences in advanced CKD, best treatments for counteracting SHPT from stage 3 CKD are still debated. Enthusiasm on prescription of vitamin D receptor activators (VDRA) in non-dialysis renal patients, has been mitigated by the risk of low bone turnover and positive calcium-phosphate balance. Nutritional vitamin D is now suggested as first-line therapy to treat SHPT with low 25(OH)D insufficiency. However, no high-grade evidence supports the best choice between ergocalciferol, cholecalciferol, and calcifediol (in its immediate or extended-release formulation).Areas covered: The review discusses available data on safety and efficacy of nutritional vitamin D, VDRA and nutritional therapy in replenishing 25(OH)D deficiency and counteracting SHPT in non-dialysis CKD patients.Expert opinion: Best treatment for low 25(OH)D and SHPT remains unknown, due to incomplete understanding of the best homeostatic, as mutable, adaptation of mineral metabolism to CKD progression. Nutritional vitamin D and nutritional therapy appear safest interventions, whenever contextualized with single-patient characteristics. VDRA should be restricted to uncontrolled SHPT by first-line therapy.
Current treatment options for secondary hyperparathyroidism in patients with stage 3 to 4 chronic kidney disease and vitamin D deficiency / A. Galassi, P. Ciceri, G. Porata, R. Iatrino, G. Boni Brivio, E. Fasulo, L. Magagnoli, A. Stucchi, M. Frittoli, A. Cara, M. Cozzolino. - In: EXPERT OPINION ON DRUG SAFETY. - ISSN 1474-0338. - (2021 Jun 09). [Epub ahead of print]
Titolo: | Current treatment options for secondary hyperparathyroidism in patients with stage 3 to 4 chronic kidney disease and vitamin D deficiency | |
Autori: | COZZOLINO, MARIO GENNARO (Ultimo) | |
Parole Chiave: | 25(Oh)D; CKD; secondary hyperparathyroidism; VDRA; calcifediol; cholecalciferol; nutritional therapy | |
Settore Scientifico Disciplinare: | Settore MED/14 - Nefrologia | |
Data di pubblicazione: | 9-giu-2021 | |
Rivista: | ||
Tipologia: | Article (author) | |
Data ahead of print / Data di stampa: | 9-giu-2021 | |
Digital Object Identifier (DOI): | http://dx.doi.org/10.1080/14740338.2021.1931117 | |
Appare nelle tipologie: | 01 - Articolo su periodico |
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