Renal Division, ASST Santi Paolo e Carlo, Department of Health Sciences, S. Paolo Hospital, University of Milan, Via A. di Rudinì, 8, 20142, Milan, Italy.
Renal Research Laboratory, Department of Nephrology, Dialysis and Renal Transplant, Fondazione Ca' Granda IRCCS, Ospedale Maggiore Policlinico, Milan, Italy.
Drugs Aging. 2019 Oct;36(10):885-895. doi: 10.1007/s40266-019-00696-3.
Secondary hyperparathyroidism (SHPT) is a major complication of chronic kidney disease (CKD), responsible for skeletal and vascular damage with increased risk of bone fractures, cardiovascular events, and mortality. However, the optimal serum parathormone (PTH) levels for improving clinical outcomes remain uncertain. Treatment of SHPT is based on nutritional therapy, phosphate binders, vitamin D, and calcimimetics, but none of these interventions has ever been tested against placebo in randomized controlled trials. Treatment of SHPT in the elderly should consider the many peculiarities of aging in terms of physiopathology, quality of life, symptoms, subjective perception of disease, drug load, and the modifying effect of treatment on disease-related outcomes. Unfortunately, peculiarities of SHPT among elderly CKD patients are mainly unexplored. The present review aims to provide a reasonable merging of evidence regarding the management of SHPT in CKD, with more actual concepts on how to care for older patients.
继发性甲状旁腺功能亢进症（SHPT）是慢性肾脏病（CKD）的主要并发症，可导致骨骼和血管损伤，增加骨折、心血管事件和死亡的风险。然而，改善临床结局的最佳血清甲状旁腺激素（PTH）水平仍不确定。SHPT 的治疗基于营养治疗、磷酸盐结合剂、维生素 D 和钙敏感受体激动剂，但这些干预措施在随机对照试验中都没有与安慰剂进行过比较。SHPT 的老年患者治疗应考虑到衰老在生理学、生活质量、症状、疾病主观感知、药物负荷以及治疗对疾病相关结局的影响方面的诸多特点。不幸的是，老年 CKD 患者的 SHPT 特点主要尚未得到探索。本综述旨在提供有关 CKD 中 SHPT 管理的合理证据综合，以及如何更好地照顾老年患者的实际概念。
