PTH Receptors and Skeletal Resistance to PTH Action

Bover, Jordi; Ureña-Torres, Pablo; Evenepoel, Pieter; Lloret, M.; Guirado, Lluís; Rodríguez, Mariano

doi:10.1007/978-3-030-43769-5_4

Cited by 3 publications

(2 citation statements)

References 174 publications

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“…Nevertheless, ∼25% of patients keep elevated iPTH levels after transplantation. This hyperparathyroidism originates either from persistent CKD–MBD characterized by, among others, previous parathyroid hyperplasia associated with an elevated calcium set-point for inhibition of PTH secretion, or from the improved ‘skeletal resistance’, an often unnoticed condition of hyporesponsiveness to PTH effect, resulting from multiple factors, including uremia per se [ 5 ]. Mild hypercalcaemia secondary to persistent hyperparathyroidism is observed in around 30% of KT recipients at 1 year [ 6 ], whether they have been previously treated by cinacalcet or not.…”

Section: Discussionmentioning

confidence: 99%

Severe hypercalcaemia early after kidney transplantation in two patients with severe secondary hyperparathyroidism previously treated with etelcalcetide

Dachy

Pochet

Labriola

et al. 2021

Clinical Kidney Journal

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Cinacalcet and more recently etelcalcetide revolutionized the treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney transplant (KT) usually improves CKD-MBD. However, a significant proportion of KT recipients have high serum calcium levels, not requiring any treatment. We report two patients previously treated by etelcalcetide who developed severe (> 3.3 mmol/L) hypercalcemia in the early post-KT course, requiring parathyroidectomy. Pathological studies showed parathyroid adenomas and hyperplasia. One patient had a graft biopsy showing numerous intratubular calcium phosphate crystals. These observations should prompt pharmacovigilance studies and careful follow-up of KT recipients previously treated by etelcalcetide.

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Section: Discussionmentioning

confidence: 99%

Severe hypercalcaemia early after kidney transplantation in two patients with severe secondary hyperparathyroidism previously treated with etelcalcetide

Dachy

Pochet

Labriola

et al. 2021

Clinical Kidney Journal

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“…A different reasonable approach is suggested by some (J. V. Torregrosa et al ., submitted for publication in the Spanish Society of Nephrology journal “Nefrologia”) to avoid an induced and probably inadequate normalization of serum PTH levels in these patients without the need for passive ‘waiting’ until something becomes sufficiently ‘severe’ to consider treatment. Actually, some degree of secondary hyperparathyroidism may be beneficial in CKD patients (PTH is a phosphaturic hormone and is necessary for a normal bone formation rate) due to the presence of PTH hyporesponsiveness (PTH resistance) in CKD [ 52 , 53 ]. Whether these 2017 KDIGO changes will result in a greater number of patients reaching later PTH extremes of risk or real improvement in patient-level outcomes remains to be seen.…”

Section: Kdigo Ckd–mbd Guidelinesmentioning

confidence: 99%

Evidence in chronic kidney disease–mineral and bone disorder guidelines: is it time to treat or time to wait?

Bover

Ureña-Torres

Mateu

et al. 2020

Clinical Kidney Journal

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Chronic kidney disease–mineral and bone disorder (CKD–MBD) is one of the many important complications associated with CKD and may at least partially explain the extremely high morbidity and mortality among CKD patients. The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline document was based on the best information available at that time and was designed not only to provide information but also to assist in decision-making. In addition to the international KDIGO Work Group, which included worldwide experts, an independent Evidence Review Team was assembled to ensure rigorous review and grading of the existing evidence. Based on the evidence from new clinical trials, an updated Clinical Practice Guideline was published in 2017. In this review, we focus on the conceptual and practical evolution of clinical guidelines (from eMinence-based medicine to eVidence-based medicine and ‘living’ guidelines), highlight some of the current important CKD–MBD-related changes, and underline the poor or extremely poor level of evidence present in those guidelines (as well as in other areas of nephrology). Finally, we emphasize the importance of individualization of treatments and shared decision-making (based on important ethical considerations and the ‘best available evidence’), which may prove useful in the face of the uncertainty over the decision whether ‘to treat’ or ‘to wait’.

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Chronic Kidney Disease–Mineral and Bone Disorders

Portales‐Castillo

Jüppner

et al. 2021

Approaches to Chronic Kidney Disease

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PTH Receptors and Skeletal Resistance to PTH Action

Cited by 3 publications

References 174 publications

Severe hypercalcaemia early after kidney transplantation in two patients with severe secondary hyperparathyroidism previously treated with etelcalcetide

Severe hypercalcaemia early after kidney transplantation in two patients with severe secondary hyperparathyroidism previously treated with etelcalcetide

Evidence in chronic kidney disease–mineral and bone disorder guidelines: is it time to treat or time to wait?

Chronic Kidney Disease–Mineral and Bone Disorders

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