| Theme | The appropriate management for CKD-MBD in the elderly patients | |
|---|---|---|
| Title | Approach to secondary hyperparathyroidism | |
| Publish Date | 2016/06 | |
| Author | Mari Ishida | Division of Nephrology, Endocrinology and Metabolism, Tokai University Hachioji Hospital |
| Author | Takatoshi Kakuta | Division of Nephrology, Endocrinology and Metabolism, Tokai University Hachioji Hospital |
| [ Summary ] | Modified treat-to-target and target range guidelines for secondary hyperparathyroidism (SHPT) have been developed by the Kidney Disease Outcomes Quality Initiative (KDOQI), Kidney Disease：Improving Global Outcomes （KDIGO）, and the Japanese Society for Dialysis Therapy (JSDT). Vitamin D receptor activators (VDRA) and cinacalcet hydrochloride have also changed the targets of interventional therapy for SHPT patients. In Japan, percutaneous ethanol injection therapy (PEIT) has developed as an intervention for isolated parathyroid hyperplasia. The number of parathyroidectomies has been decreasing since the introduction of cinacalcet. However, not only decreased parathyroid hormone (PTH) levels but also parathyroidectomies have reduced the number of hip bone fractures and mortality of end-stage renal disease (ESRD) patients on hemodialysis. Therefore, parathyroidectomy is the ultimate weapon against SHPT and makes it easier to achieve targets for calcium and phosphorus as well as significant reduction of PTH levels. More than 70 % of ESRD patients receiving hemodialysis are over 65 years old, and must receive intensive treatment to avoid comorbidities and frailty, as well as to reduce mortality and medical costs. |
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