| Theme |
Evidence-based strategies for secondary hyperparathyroidism |
| Title |
Clinical priorities based on evidence and opinion: Directivity of the new guidelines |
| Author |
Takayuki Hamano |
Division of Nephrology, Department of Internal Medicine and Therapeutics, Osaka University School of Medicine |
| Author |
Takahito Ito |
Division of Nephrology, Department of Internal Medicine and Therapeutics, Osaka University School of Medicine |
| Author |
Masafumi Fukagawa |
Division of Nephrology and Dialysis Center, Kobe University School of Medicine |
| [ Summary ] |
In 2000 and 2003, the European Renal Association and the NKF K/DOQI released new clinical practice guidelines for bone metabolism and disease in chronic kidney disease (CKD), respectively. Both of these guidelines, apparently not only for bone disease, are based on cumulative evidence and attach great importance to mortality. Especially, the K/DOQI guideline places greater stress on lower target levels regarding serum concentrations of calcium and phosphate and calcium phosphate products in order to reduce cardiovascular complications due to extra-osseous (especially vascular and valvular) calcification. Prescription of a new phosphate binder, sevelamer hydrochloride, which has been recently introduced to clinical practice in Japan, is widely recommended in this guideline. These guidelines remind us that in CKD the strict control of bone metabolism reduces mortality as well as improves the prognosis for bone diseases. |