副甲状腺をターゲットとしたCKD-MBD治療

Parathyroid Hormone. Treatment of CKD-MBD targeting the parathyroid gland.

　二次性副甲状腺機能亢進症はchronic kidney disease-mineral and bone disorder（CKD-MBD）の中心的病態の一つであり，高回転型骨病変，血管石灰化を介してCKD患者の予後に深刻な影響を及ぼす。このような観点から，二次性副甲状腺機能亢進症の管理は，CKD患者の予後改善を図る上で最も重要な課題の一つである。二次性副甲状腺機能亢進症の病態は保存期と透析期で異なるため，治療アプローチも分けて考える必要がある。本稿では，副甲状腺をターゲットとしたCKD-MBD治療について，保存期と透析期の病態の違いに着目して概説する。

　Secondary hyperparathyroidism is a major component of chronic kidney disease-mineral and bone disorder（CKD-MBD）and has a considerable impact on morbidity and mortality through the development of high-turnover bone disease and vascular calcification. Thus, management of secondary hyperparathyroidism is important for improving the outcomes of CKD patients. Because there is a fundamental difference in the pathogenesis of secondary hyperparathyroidism between predialysis and dialysis patients, different therapeutic approach should be considered for each condition. In this article, we summarize the treatment of CKD-MBD for managing secondary hyperparathyroidism, with a particular focus on the difference between predialysis and dialysis stages of CKD.