CIN '2007 - 4th CONGRESS OF NEPHROLOGY IN INTERNET
The treatment of mineral metabolism disorders: A recent approach with new compounds and a proposed algorithm.
Dr João M. Frazão
Nephrology Research and Development Unit and School of Medicine, Porto University, Porto
Abstract
During the last few years there have been major developments in the management of bone and mineral disorders in chronic kidney disease (CKD) stage 5 haemodialysis patients. The knowledge that these bone and mineral abnormalities impact heavily on morbidity and mortality means the practicing nephrologist must pay major attention to control these alterations. In addition, new compounds have been developed for the control of hyperphosphataemia and for the treatment of secondary hyperparathyroidism (SHPT). Many practical questions have been raised by nephrologists on the use of non-calcium containing phosphate binders. Furthermore, the use of the new calcimimetic agent, cinacalcet, that suppresses PTH secretion and, in contrast with the effect of active vitamin D, lowers calcium and phosphorus serum levels, brings new questions and concerns to the mind of the clinical nephrologists taking care of dialysis patients. Based on published data and recommendations, a practical treatment algorithm will be proposed at the end of this lecture which combines the treatment of hyperphosphatemia and secondary hyperparathyroidism and highlights synergies between different compounds such as sevelamer, cinacalcet and active vitamin D.Comments: