Abstract
Hemodialysis (HD) patients are commonly affected by secondary hyperparathyroidism (SHPT), in which 3 well-known factors are usually involved: hypocalcemia, hyperphosphatemia and calcitriol deficiency. Classically, high parathyroid hormone (PTH) levels cause bone-associated diseases, such as osteitis fibrosa and renal osteodystrophy, but more recently it has been demonstrated the link between SHPT and a systemic toxicity, with a major role in determining cardio-vascular disease, including arterial calcification, endocrine disturbances, compromised immune system, neurobehavioral changes, and altered erythropoiesis. Treatment with calcitriol (CT), the active form of vitamin D, reduces parathyroid hormone (PTH) levels, but may result in elevations in serum calcium (Ca) and phosphorus (P), increasing the risk of cardio-vascular calcification in the HD population. Several new vitamin D analogs have been developed and investigated with the rationale to treat SHPT with a reduced risk of hypercalcemia and hyperphosphatemia in HD patients. Paricalcitol (1,25-dihydroxy-19-nor-vitamin D2, 19- Nor-D2) is a vitamin D analog that suppresses PTH secretion with minimal increases on serum calcium and phosphate levels. It was demonstrated that paricalcitol prevents vascular calcification in experimental models of renal failure, compared with calcitriol. Furthermore, 19-Nor-D2 is the first analog approved for use in HD patients and is available for i.v. and oral administration, commonly 3 times weekly after HD. The purpose of the present review is to analyze the pathogenesis and treatment of SHPT in HD patients, and the role of paricalcitol in the prevention of arterial calcification.
Keywords: Paricalcitol, parathyroid hormone, calcium, phosphorus, dialysis
Current Vascular Pharmacology
Title: Pathogenesis and Treatment of Secondary Hyperparathyroidism in Dialysis Patients: The Role of Paricalcitol
Volume: 6 Issue: 2
Author(s): Mario Cozzolino, Andrea Galassi, Maurizio Gallieni and Diego Brancaccio
Affiliation:
Keywords: Paricalcitol, parathyroid hormone, calcium, phosphorus, dialysis
Abstract: Hemodialysis (HD) patients are commonly affected by secondary hyperparathyroidism (SHPT), in which 3 well-known factors are usually involved: hypocalcemia, hyperphosphatemia and calcitriol deficiency. Classically, high parathyroid hormone (PTH) levels cause bone-associated diseases, such as osteitis fibrosa and renal osteodystrophy, but more recently it has been demonstrated the link between SHPT and a systemic toxicity, with a major role in determining cardio-vascular disease, including arterial calcification, endocrine disturbances, compromised immune system, neurobehavioral changes, and altered erythropoiesis. Treatment with calcitriol (CT), the active form of vitamin D, reduces parathyroid hormone (PTH) levels, but may result in elevations in serum calcium (Ca) and phosphorus (P), increasing the risk of cardio-vascular calcification in the HD population. Several new vitamin D analogs have been developed and investigated with the rationale to treat SHPT with a reduced risk of hypercalcemia and hyperphosphatemia in HD patients. Paricalcitol (1,25-dihydroxy-19-nor-vitamin D2, 19- Nor-D2) is a vitamin D analog that suppresses PTH secretion with minimal increases on serum calcium and phosphate levels. It was demonstrated that paricalcitol prevents vascular calcification in experimental models of renal failure, compared with calcitriol. Furthermore, 19-Nor-D2 is the first analog approved for use in HD patients and is available for i.v. and oral administration, commonly 3 times weekly after HD. The purpose of the present review is to analyze the pathogenesis and treatment of SHPT in HD patients, and the role of paricalcitol in the prevention of arterial calcification.
Export Options
About this article
Cite this article as:
Cozzolino Mario, Galassi Andrea, Gallieni Maurizio and Brancaccio Diego, Pathogenesis and Treatment of Secondary Hyperparathyroidism in Dialysis Patients: The Role of Paricalcitol, Current Vascular Pharmacology 2008; 6 (2) . https://dx.doi.org/10.2174/157016108783955310
DOI https://dx.doi.org/10.2174/157016108783955310 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
Call for Papers in Thematic Issues
Ischemic Cardiovascular Diseases: Mechanisms, Diagnosis and Therapy
Ischemic cardiovascular disease includes myocardial infarction, coronary atherosclerotic heart disease, angina pectoris, etc., constitute the leading cause of patient mortality by preventing tissues from getting sufficient oxygen and nutrients. Ischemic heart disease, as a clinical condition, is characterized by myocardial ischemia, causing an imbalance between myocardial blood supply and demand, ...read more
TREATMENT OF CARDIOVASCULAR DISEASE IN CHRONIC AND END STAGE KIDNEY DISEASE
Cardiovascular disease still remains the leading cause of death in Chronic and End Stage Kidney Disease, accounting for more than half of all deaths in dialysis patients. During the past decade, research has been focused on novel therapeutic agents that might delay or even reverse cardiovascular disease and vascular calcification, ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
The Role of C-Reactive Protein in Atherosclerotic Cardiovascular Disease: An Overview
Current Vascular Pharmacology Comparative Pharmacokinetics and Metabolism Studies in Lean and Diet- Induced Obese Mice: An Animal Efficacy Model for 11β -Hydroxysteroid Dehydrogenase Type 1 (11β -HSD1) Inhibitors
Drug Metabolism Letters Biological Markers in Older People at Risk of Mobility Limitations
Current Pharmaceutical Design Recent Progress in the Development of Natural ent-Kaurane Diterpenoids with Anti-tumor Activity
Mini-Reviews in Medicinal Chemistry Phytocompounds as Potential Agents to Treat Obesity-Cardiovascular Ailments
Cardiovascular & Hematological Agents in Medicinal Chemistry Specific Nutritional Needs for Children: Are Children Small Adults?
Current Pediatric Reviews Non-Invasive Methods and Techniques for Central Blood Pressure Estimation: Procedures, Validation, Reproducibility and Limitations
Current Pharmaceutical Design Management of Incidental Findings in the Era of Next-generation Sequencing
Current Genomics Subject Index To Volume 2
Current Cardiology Reviews Rac-1 as a New Therapeutic Target in Cerebro- and Cardio-Vascular Diseases
Current Drug Targets Therapeutic Modulation of Coagulation and Fibrinolysis in Acute Lung Injury and the Acute Respiratory Distress Syndrome
Current Pharmaceutical Biotechnology Obesity and Oxidative Stress: Potential Roles of Melatonin as Antioxidant and Metabolic Regulator
Endocrine, Metabolic & Immune Disorders - Drug Targets Editorial (Hot Topic: Hypertension: A Serious Complication in Pregnancy)
Current Hypertension Reviews Cerebral Aneurysm Formation in Nitric Oxide Synthase-3 Knockout Mice
Current Neurovascular Research Pleiotropic Effects of the Rho-kinase Inhibitor Fasudil After Subarachnoid Hemorrhage: A Review of Preclinical and Clinical Studies
Current Vascular Pharmacology Development of Meat and Poultry Products Enriched with n-3 PUFAs and their Functional Role
Current Nutrition & Food Science Nanocarriers Assisted siRNA Gene Therapy for the Management of Cardiovascular Disorders
Current Pharmaceutical Design Adipose Tissue as a Regulator of Energy Balance
Current Drug Targets Growth Factors in the Pathogenesis of Retinal Neurodegeneration in Diabetes Mellitus
Current Neuropharmacology Overactive Bladder - Current Treatment Modalities
Current Women`s Health Reviews