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Albeit not ideal, PTH accuracy increases with extreme values (i.e. below two and above nine times of the reference range) of PTH [20, 21]. It is plausible that in spite of the high [https://en.wikipedia.org/wiki/Amiloride Amiloride] PTH levels [median (interquartile range): 721 pg/mL (506�C1050)] at study entry, a minority of the patients recruited in the ECHO study had a low-bone turnover characterized by high serum phosphorous levels and likely worsened by a calcimimetic treatment. In a recent series of 163 iliac crest bone biopsies of CKD-5D individuals, it was observed that serum phosphorus trends towards higher levels in both low- and high-bone turnover disease [21]. While a low or adynamic bone disease is characterized by a low capacity of the bones to accommodate the phosphorous load coming from the diet, high-bone turnover disease is characterized [http://www.selleckchem.com/products/PLX-4032.html Vemurafenib] by a substantial removal of minerals from the bones. The latter may potentially explain why patients with higher PTH tend to experience a greater serum phosphorous reduction. These results are limited by a substantial loss of patients to follow-up and by the lack of information on phosphate intake at baseline and at study conclusion. Indeed, low serum albumin, a marker of malnutrition, was associated with low serum phosphate in the ECHO study [16]. Nonetheless, the authors suggest that at least in patients with a considerable phosphorous removal from the bone, treatment with a calcimimetic may be beneficial to normalize bone metabolism through PTH reduction. The clinical impact of serum phosphorous reduction on the relevant outcome is far from being established, especially in light of the recently published results of the EVOLVE trial [2], and future studies should address whether high-bone turnover attenuation increases survival among CKD-5D subjects. Conflict of interest statement None declared.""The prevalence of chronic kidney disease (CKD) defined as the estimated eGFR [http://www.selleckchem.com/products/INCB18424.html Selleckchem Ruxolitinib] ageing populations [2�C4]. Although only a small proportion of all CKD patients progress to end-stage renal disease (ESRD), needing the resource-intensive treatment with renal replacement therapy (RRT, dialysis or kidney transplantation), the cost of treatment for this patient group, roughly 0.1% of the population, comprise 1�C2% of the total health care spending in high-income countries [2]. The RRT incidence is routinely collected by renal registries in many countries and shows a 45-fold variation across the world [5].