The calcium-sensing receptor (CaSR) represents the molecular mechanism by which parathyroid cells detect changes in blood ionized calcium concentration and modulate parathyroid hormone (PTH) secretion to maintain serum calcium levels within a narrow physiological range. Much has been learned in recent years about the diversity of signal transduction through the CaSR and the various factors that affect receptor expression. Beyond its classic role as a determinant of calcium-regulated PTH secretion, signaling through the CaSR also influences both gene transcription and cell proliferation in parathyroid cells. The CaSR thus serves a broad physiological role by integrating several distinct aspects of parathyroid gland function. The current review summarizes recent developments that enhance our understanding of the CaSR and its fundamental importance in parathyroid gland physiology.

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Chronic kidney disease (CKD) is a growing epidemic in the United States and worldwide, with nearly two thirds of CKD patients also having diabetes, hypertension, or both. Morbidity and mortality among patients with CKD are high, as are the costs associated with care, which is highly fragmented. Disease management (DM) programs are designed to coordinate the delivery of care to patients, improve clinical outcomes, and reduce costs along the continuum of care. The goals of DM programs in CKD patients are to fill the gaps in current care by focusing on four key areas: (1) slowing the progression of CKD, (2) identifying and managing the complications of CKD, (3) identifying and managing associated comorbid conditions, and (4) smoothing the transition to renal replacement therapy (RRT). To be successful, this approach requires multidisciplinary collaboration among physicians (eg, primary care physicians, endocrinologists, cardiologists, nephrologists, surgeons) and participating caregivers including nurses, dieticians, social workers, and pharmacists. Patient identification, limited reimbursement, late patient referral, and lack of primary care physician and nephrologist knowledge about the importance and details of CKD management are all barriers that must be overcome for such programs to be successfully implemented. Considering the magnitude of the opportunity, DM applied to CKD is a promising approach to the care of this vulnerable population.