Amgen is committed to unlocking the potential of biology for patients suffering from serious illnesses by discovering, developing, manufacturing and delivering innovative human therapeutics. This approach begins by using tools like advanced human genetics
William G. Goodman, MD, has served as a speaker for Abbott Laboratories, Amgen, Genzyme, and Kirin Pharmaceuticals.He has also served as a consultant for Amgen, Quest-Nichols, Genzyme, and Kirin.Dr. Goodman owns stock in Amgen and Abbott Laboratories.As Professor of Medicine at UCLA, Dr. Goodman contributed to the CRESCENTÔ content.Effective September 2006, Dr. Goodman will be employed at Amgen.
Mednet - CME, CHE | Management of Bone and Mineral Abnormalities in Chronic Kidney Disease
â€œThis decline occurs before there is any elevation in serum phosphorus,â€� Dr. William Goodman, Professor of Medicine, David Geffen School of Medicine, noted.
Abnormalities in vitamin D metabolism in turn adversely affect intestinal calcium transport.
Thus, in Dr. Goodmanâ€™s view, elevations in PTH in early-stage CKD is an appropriate physiological response that helps maintain serum calcium levels.
In both healthy individuals as well as in patients with mild to moderate CKD, phosphorus loading impairs the kidneyâ€™s production of 1,25-dihydroxyvitamin D3, while restricting phosphorus will increase its production.
The literature suggests that even if phosphorus level is normal, restricting phosphorus in the diet or through the use of phosphate binders will drive up 1,25-dihydroxy-vitamin D3 production and help prevent bone disease.
Increases in 1,25-dihydroxyvitamin D3 levels correspond with subsequent reductions in plasma PTH levels, â€œso it is the change in circulating 1,25-dihydroxyvitamin D3 levels that mediates the reduction in PTH, not phosphorus per se,â€� Dr. Goodman indicated.
He also argued that patients with earlier-stage CKD are fundamentally different than those on dialysis, largely because they still have residual kidney function and they can excrete phosphorus.
In patients who have mild to moderate CKD, serum phosphorus levels are usually normal, while serum calcium levels are typically in the lower range of normal, he added; and the fact that patients with mild CKD excrete relatively little calcium is a sign that the kidney is trying to conserve calcium. â€œIâ€™m not arguing with the fact that phosphate restriction and phosphate binders are appropriate when serum phosphate levels are elevated,â€� Dr. Goodman stated.
Data supporting a non-calcium-based phosphate binder strategy are limited but one prospective studyâ€"the â€œtreat-to-goalâ€� trialâ€"showed that vascular calcification did not worsen over one year of follow-up in dialysis patients treated with sevelamer, whereas it did progress in patients treated with a calcium phosphate binder. â€œTheoretically, the use of lanthanum carbonate might have a similar beneficial effect because it is also calcium-free,â€� Dr. Goodman indicated, although this has not yet been demonstrated in a prospective trial.
However, he stated that the choice of a phosphate binding agent could influence progression of calcification once it is present, even though it is not clear how vascular calcification develops in the first place.
â€œYour choice of phosphate binder is going to be influenced very significantly by other biochemical abnormalities,â€� Dr. Goodman cautioned.
In an interview, Dr. Goodman also suggested that this agent might be equivalent in potency to the old aluminum-containing binders and more potent than calcium carbonate nor calcium acetate.
William G. Goodman, MD, is Professor of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), where he is Director of the Bone Histology Laboratory at UCLA Medical Center.After earning his medical degree from The Ohio State University College of Medicine in Columbus, Dr. Goodman completed an internship and residency in internal medicine at Henry Ford Hospital in Detroit, Michigan, where he served as chief resident.Following residency, Dr. Goodman completed a fellowship in nephrology at the University of Washington in Seattle.He is board-certified in internal medicine and nephrology.Dr. Goodman's research on secondary hyperparathyroidism, renal osteodystrophy, and vascular calcification in patients on dialysis has been published in numerous peer-reviewed journals, including The New England Journal of Medicine, Kidney International, American Journal of Kidney Disease, and Pediatric Nephrology.He has contributed to more than 20 book chapters and 150 abstracts.He sits on the editorial boards of Journal of the American Society of Nephrology and Kidney International and serves as a reviewer for a number of scientific publications including The Journal of Clinical Investigation, The New England Journal of Medicine, and The Lancet, among others.Dr. Goodman's commitment to his field extends to the community where he has served as a member of the Scientific Advisory Council of the National Kidney Foundation of Southern California and as a member of the Program Committee for the NKF spring clinical meetings.He is a 20-year member of many professional organizations, including the American Society of Nephrology, the International Society of Nephrology, and The American Society for Bone and Mineral Research.
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