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Searching the optimal PTH target range in children undergoing peritoneal dialysis: New insights from international cohort studies

The treatment of the mineral and bone disorder associated with chronic kidney disease (CKD-MBD) remains a major challenge in pediatric patients. The principal aims of therapeutic measures are not only to prevent the debilitating skeletal complications and to achieve normal growth but also to preserv... Full description

Journal Title: Pediatric nephrology (Berlin West), 2012-08-15, Vol.28 (4), p.537-545
Main Author: Haffner, Dieter
Other Authors: Schaefer, Franz
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Berlin/Heidelberg: Springer-Verlag
ID: ISSN: 0931-041X
Link: https://www.ncbi.nlm.nih.gov/pubmed/22893310
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recordid: cdi_proquest_miscellaneous_1314894975
title: Searching the optimal PTH target range in children undergoing peritoneal dialysis: New insights from international cohort studies
format: Article
creator:
  • Haffner, Dieter
  • Schaefer, Franz
subjects:
  • Adolescent
  • Animals
  • Biomarkers - blood
  • Bone Remodeling
  • Cardiovascular Diseases - blood
  • Cardiovascular Diseases - diagnosis
  • Cardiovascular Diseases - etiology
  • Cardiovascular Diseases - physiopathology
  • Cardiovascular Diseases - prevention & control
  • Care and treatment
  • Child
  • Child, Preschool
  • Chronic Kidney Disease-Mineral and Bone Disorder - blood
  • Chronic Kidney Disease-Mineral and Bone Disorder - diagnosis
  • Chronic Kidney Disease-Mineral and Bone Disorder - etiology
  • Chronic Kidney Disease-Mineral and Bone Disorder - physiopathology
  • Chronic Kidney Disease-Mineral and Bone Disorder - prevention & control
  • Chronic kidney failure
  • Complications and side effects
  • Continuous ambulatory peritoneal dialysis
  • Guideline Adherence
  • Health aspects
  • Humans
  • Hyperparathyroidism, Secondary - blood
  • Hyperparathyroidism, Secondary - diagnosis
  • Hyperparathyroidism, Secondary - etiology
  • Hyperparathyroidism, Secondary - physiopathology
  • Hyperparathyroidism, Secondary - prevention & control
  • Infant
  • Medicine
  • Medicine & Public Health
  • Nephrology
  • Parathyroid hormone
  • Parathyroid Hormone - blood
  • Pediatrics
  • Peritoneal dialysis
  • Peritoneal Dialysis - adverse effects
  • Peritoneal Dialysis - standards
  • Practice Guidelines as Topic
  • Registries
  • Renal Insufficiency, Chronic - blood
  • Renal Insufficiency, Chronic - complications
  • Renal Insufficiency, Chronic - diagnosis
  • Renal Insufficiency, Chronic - physiopathology
  • Renal Insufficiency, Chronic - therapy
  • Review
  • Treatment Outcome
  • Urology
ispartof: Pediatric nephrology (Berlin, West), 2012-08-15, Vol.28 (4), p.537-545
description: The treatment of the mineral and bone disorder associated with chronic kidney disease (CKD-MBD) remains a major challenge in pediatric patients. The principal aims of therapeutic measures are not only to prevent the debilitating skeletal complications and to achieve normal growth but also to preserve long-term cardiovascular health. Serum parathyroid hormone (PTH) levels are used as a surrogate parameter of bone turnover. Whereas it is generally accepted that serum calcium and phosphate levels should be kept within the range for age, current pediatric consensus guidelines differ markedly with respect to the optimal PTH target range and operate on a limited evidence base. Recently, the International Pediatric Dialysis Network (IPPN) established a global registry collecting detailed clinical and biochemical information, including data relevant to CKD-MBD in children on chronic peritoneal dialysis (PD). This review highlights the current evidence basis regarding the optimal PTH target range in pediatric CKD patients, and re-assesses the current guidelines in view of the outcome data collected by the IPPN registry. Based on a comprehensive evaluation of CKD-MBD outcome measures in this global patient cohort, a PTH target range of 1.7–3 times the upper limit of normal (i.e. 100–200 pg/ml) appears reasonable in children undergoing chronic PD.
language: eng
source:
identifier: ISSN: 0931-041X
fulltext: no_fulltext
issn:
  • 0931-041X
  • 1432-198X
url: Link


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titleSearching the optimal PTH target range in children undergoing peritoneal dialysis: New insights from international cohort studies
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descriptionThe treatment of the mineral and bone disorder associated with chronic kidney disease (CKD-MBD) remains a major challenge in pediatric patients. The principal aims of therapeutic measures are not only to prevent the debilitating skeletal complications and to achieve normal growth but also to preserve long-term cardiovascular health. Serum parathyroid hormone (PTH) levels are used as a surrogate parameter of bone turnover. Whereas it is generally accepted that serum calcium and phosphate levels should be kept within the range for age, current pediatric consensus guidelines differ markedly with respect to the optimal PTH target range and operate on a limited evidence base. Recently, the International Pediatric Dialysis Network (IPPN) established a global registry collecting detailed clinical and biochemical information, including data relevant to CKD-MBD in children on chronic peritoneal dialysis (PD). This review highlights the current evidence basis regarding the optimal PTH target range in pediatric CKD patients, and re-assesses the current guidelines in view of the outcome data collected by the IPPN registry. Based on a comprehensive evaluation of CKD-MBD outcome measures in this global patient cohort, a PTH target range of 1.7–3 times the upper limit of normal (i.e. 100–200 pg/ml) appears reasonable in children undergoing chronic PD.
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languageeng
publisherBerlin/Heidelberg: Springer-Verlag
subjectAdolescent ; Animals ; Biomarkers - blood ; Bone Remodeling ; Cardiovascular Diseases - blood ; Cardiovascular Diseases - diagnosis ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - physiopathology ; Cardiovascular Diseases - prevention & control ; Care and treatment ; Child ; Child, Preschool ; Chronic Kidney Disease-Mineral and Bone Disorder - blood ; Chronic Kidney Disease-Mineral and Bone Disorder - diagnosis ; Chronic Kidney Disease-Mineral and Bone Disorder - etiology ; Chronic Kidney Disease-Mineral and Bone Disorder - physiopathology ; Chronic Kidney Disease-Mineral and Bone Disorder - prevention & control ; Chronic kidney failure ; Complications and side effects ; Continuous ambulatory peritoneal dialysis ; Guideline Adherence ; Health aspects ; Humans ; Hyperparathyroidism, Secondary - blood ; Hyperparathyroidism, Secondary - diagnosis ; Hyperparathyroidism, Secondary - etiology ; Hyperparathyroidism, Secondary - physiopathology ; Hyperparathyroidism, Secondary - prevention & control ; Infant ; Medicine ; Medicine & Public Health ; Nephrology ; Parathyroid hormone ; Parathyroid Hormone - blood ; Pediatrics ; Peritoneal dialysis ; Peritoneal Dialysis - adverse effects ; Peritoneal Dialysis - standards ; Practice Guidelines as Topic ; Registries ; Renal Insufficiency, Chronic - blood ; Renal Insufficiency, Chronic - complications ; Renal Insufficiency, Chronic - diagnosis ; Renal Insufficiency, Chronic - physiopathology ; Renal Insufficiency, Chronic - therapy ; Review ; Treatment Outcome ; Urology
ispartofPediatric nephrology (Berlin, West), 2012-08-15, Vol.28 (4), p.537-545
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descriptionThe treatment of the mineral and bone disorder associated with chronic kidney disease (CKD-MBD) remains a major challenge in pediatric patients. The principal aims of therapeutic measures are not only to prevent the debilitating skeletal complications and to achieve normal growth but also to preserve long-term cardiovascular health. Serum parathyroid hormone (PTH) levels are used as a surrogate parameter of bone turnover. Whereas it is generally accepted that serum calcium and phosphate levels should be kept within the range for age, current pediatric consensus guidelines differ markedly with respect to the optimal PTH target range and operate on a limited evidence base. Recently, the International Pediatric Dialysis Network (IPPN) established a global registry collecting detailed clinical and biochemical information, including data relevant to CKD-MBD in children on chronic peritoneal dialysis (PD). This review highlights the current evidence basis regarding the optimal PTH target range in pediatric CKD patients, and re-assesses the current guidelines in view of the outcome data collected by the IPPN registry. Based on a comprehensive evaluation of CKD-MBD outcome measures in this global patient cohort, a PTH target range of 1.7–3 times the upper limit of normal (i.e. 100–200 pg/ml) appears reasonable in children undergoing chronic PD.
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8Cardiovascular Diseases - prevention & control
9Care and treatment
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12Chronic Kidney Disease-Mineral and Bone Disorder - blood
13Chronic Kidney Disease-Mineral and Bone Disorder - diagnosis
14Chronic Kidney Disease-Mineral and Bone Disorder - etiology
15Chronic Kidney Disease-Mineral and Bone Disorder - physiopathology
16Chronic Kidney Disease-Mineral and Bone Disorder - prevention & control
17Chronic kidney failure
18Complications and side effects
19Continuous ambulatory peritoneal dialysis
20Guideline Adherence
21Health aspects
22Humans
23Hyperparathyroidism, Secondary - blood
24Hyperparathyroidism, Secondary - diagnosis
25Hyperparathyroidism, Secondary - etiology
26Hyperparathyroidism, Secondary - physiopathology
27Hyperparathyroidism, Secondary - prevention & control
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29Medicine
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32Parathyroid hormone
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34Pediatrics
35Peritoneal dialysis
36Peritoneal Dialysis - adverse effects
37Peritoneal Dialysis - standards
38Practice Guidelines as Topic
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40Renal Insufficiency, Chronic - blood
41Renal Insufficiency, Chronic - complications
42Renal Insufficiency, Chronic - diagnosis
43Renal Insufficiency, Chronic - physiopathology
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46Treatment Outcome
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titleSearching the optimal PTH target range in children undergoing peritoneal dialysis: New insights from international cohort studies
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1Animals
2Biomarkers - blood
3Bone Remodeling
4Cardiovascular Diseases - blood
5Cardiovascular Diseases - diagnosis
6Cardiovascular Diseases - etiology
7Cardiovascular Diseases - physiopathology
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9Care and treatment
10Child
11Child, Preschool
12Chronic Kidney Disease-Mineral and Bone Disorder - blood
13Chronic Kidney Disease-Mineral and Bone Disorder - diagnosis
14Chronic Kidney Disease-Mineral and Bone Disorder - etiology
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16Chronic Kidney Disease-Mineral and Bone Disorder - prevention & control
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18Complications and side effects
19Continuous ambulatory peritoneal dialysis
20Guideline Adherence
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26Hyperparathyroidism, Secondary - physiopathology
27Hyperparathyroidism, Secondary - prevention & control
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41Renal Insufficiency, Chronic - complications
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46Treatment Outcome
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abstractThe treatment of the mineral and bone disorder associated with chronic kidney disease (CKD-MBD) remains a major challenge in pediatric patients. The principal aims of therapeutic measures are not only to prevent the debilitating skeletal complications and to achieve normal growth but also to preserve long-term cardiovascular health. Serum parathyroid hormone (PTH) levels are used as a surrogate parameter of bone turnover. Whereas it is generally accepted that serum calcium and phosphate levels should be kept within the range for age, current pediatric consensus guidelines differ markedly with respect to the optimal PTH target range and operate on a limited evidence base. Recently, the International Pediatric Dialysis Network (IPPN) established a global registry collecting detailed clinical and biochemical information, including data relevant to CKD-MBD in children on chronic peritoneal dialysis (PD). This review highlights the current evidence basis regarding the optimal PTH target range in pediatric CKD patients, and re-assesses the current guidelines in view of the outcome data collected by the IPPN registry. Based on a comprehensive evaluation of CKD-MBD outcome measures in this global patient cohort, a PTH target range of 1.7–3 times the upper limit of normal (i.e. 100–200 pg/ml) appears reasonable in children undergoing chronic PD.
copBerlin/Heidelberg
pubSpringer-Verlag
pmid22893310
doi10.1007/s00467-012-2270-1