| [ Summary ] |
Abnormalities of mineral and bone metabolism in patients with chronic kidney disease (CKD) have traditionally been assessed and managed in terms of renal osteodystrophy (ROD). However, it has been demonstrated that abnormal mineral and bone metabolism in CKD not only produces bone lesions, but also influences the prognosis by causing ectopic calcification throughout the body, including the blood vessels, over the long term. In 2003, the K / DOQI guidelines were released by the National Kidney Foundation (NKF) in the United States. In Japan, guidelines for the treatment of secondary hyperparathyroidism in patients on dialysis (JSDT guidelines) were issued in 2006. The JSDT guidelines were drafted on the basis that PTH should be controlled, with serum phosphorus and serum calcium levels remaining under optimal control. Under these circumstances, the regulation of PTH is limited by the range of target values for serum phosphorus and calcium. P : 3.5 - 6.0 mg / dl, Ca : 8.4 - 10.0 mg/dl, intact PTH : 60 - 180 pg / ml. When serum P, Ca and PTH levels can not be maintained within target range, medical treatment including active vitamin D therapy, should not be continued and parathyroid intervention therapy should be considered to avoid progression of ectopic calcification. Parathyroid intervention therapy should be recommended in patients with severe hyperparathyroidism (persistent high serum level of intact PTH level > 500 pg / ml), associated with hyperphosphatemia (serum P > 6.0 mg / dl) and / or hypercalcemia (serum Ca > 10.0 mg / dl) that is refractory to medical therapy. |