Improvement of mineral and bone metabolism markers is associated with better survival in haemodialysis patients: the COSMOS study

Abstract

COSMOS provides evidence of the association of serum phosphorus, calcium and PTH and mortality, and suggests survival benefits of controlling chronic kidney disease-mineral and bone disorder biochemical parameters in CKD5D patients.

Secondary Hyperparathyroidism in End-Stage Renal Disease: No Longer a Matter for Surgeons?

“…Thus, both national and international guidelines suggest that the primary choice of an anti-SHPT treatment may be based upon serum Ca and P levels [4] . Moreover, in those patients with SHPT and non-pharmacological hypercalcemia (tertiary hyperparathyroidism) or in those prone to hypercalcemia, calcimimetics should be considered as first-line treatment, allowing potentially concomitant use of vitamin D. In any case, with current treatment approaches, a great proportion of patients have inadequately controlled serum PTH, P and/or Ca levels [9] . Ameliorating SHPT comorbidities may ameliorate the complex interaction among the metabolic, renal and vascular abnormalities seen in ESRD [10] .…”

The Efficacy of Cinacalcet in the Treatment of Hyperparathyroidism in Turkish Hemodialysis Patient Population

“…In recent years, it was understood to be associated with vascular calcification, valvular calcification and increased risk of death besides its negative effects on bone and was started to be called chronic kidney disease-mineral bone disorder (CKD-MBD) (1)(2)(3). Secondary hyperparathyroidism and mineral metabolism disorders begin in the early stages of kidney failure (below a GFR of approximately 60 mL/min) and while the stage of renal failure progresses, its frequency increases especially in the dialysis patient population.…”

Why Current PTH Assays Mislead Clinical Decision Making in Patients with Secondary Hyperparathyroidism

“…These preclinical data were translated to humans. Low PTH concentrations, for example, after total parathyrctomy as well as high PTH concentrations in CKD patients are associated with excess morbidity and mortality [6][7][8][9] . These studies led to the development of guidelines for the treatment of too low and in particular too high PTH status in CKD patients [10,11] and subsequently to the development of pharmaceutical tools to treat these abnormal status such as PTH analogues [12] for conditions of low PTH-related situations as well a vitamin D analogues, calcimimetics, and phosphorus binders for conditions with high PTH [13][14][15][16] .…”