FGF23 or PTH: Which comes first in CKD

Abstract

In the past 40 years, disordered mineral metabolism has been among the most intensely studied areas of nephrology. A June 2010 PubMed search for secondary hyperparathyroidism and kidney disease yielded 5866 references. Among these are papers documenting the development and application of numerous therapeutic agentsincluding calcitriol, vitamin D analogs, phosphate binders, and cinacalcetthat remain in widespread use in the day-to-day management of dialysis patients worldwide. However, almost 6000 papers later, fundamental pathophysiological concepts remain unclear, particularly regarding the early pathogenesis of disordered mineral metabolism. © 2010 International Society of Nephrology.