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Once in the cytoplasm, the pre-miRNA is further processed by the enzyme Dicer and its cofactor TRBP into a short RNA duplex

For a long time, calcitriol or alfacalcidol was the preferred therapy in uremic patients with high to very high plasma intact PTH values and normal to moderately elevated plasma calcium levels, when plasma phosphate did not exceed recommended levels, namely 1.5 mmol/L for CKD stages 3-4 and 1.8 mmol/L for CKD stage 5, according to the K/DOQI guidelines of 2003 (275)

Common neurological manifestations include: Paraesthesia (pins and needles) in the hands and feet Numbness and altered sensation Difficulty with balance and coordination (ataxia) Memory problems and cognitive impairment Mood changes, including depression and irritability In severe cases, visual disturbances and confusion These neurological features arise from demyelination of peripheral nerves and the spinal cord, a condition known as subacute combined degeneration when it affects the posterior and lateral columns of the spinal cord

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