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NDT Plus 2008 1(Supplement 1):i24-i28; doi:10.1093/ndtplus/sfm041
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© The Author [2007].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

A New Paradigm for the Treatment of Secondary Hyperparathyroidism

Angel L. M. de Francisco1 and Fernando Carrera2

1 Servicio de Nefrología, Hospital Universitario Valdecilla, Santander, Spain
2 Eurodial, Euromedic, Dialysis Unit, Leiria, Portugal

Correspondence: Angel L. M. de Francisco, Servicio de Nefrología, Hospital Universitario Valdecilla, Avda Valdecilla s/n, E-39008 Santander, Spain. E-mail: martinal{at}medi.unican.es


  Abstract

The global rise in chronic kidney disease makes secondary hyperparathyroidism (SHPT) a growing medical concern. Conventional therapies for treating SHPT are limited and include calcium-based and calcium-free phosphate binders for reducing serum phosphorus and vitamin D or its analogues for simultaneous stimulation of calcium absorption and suppression of parathyroid hormone (PTH) gene expression. Control of SHPT using these therapies has typically been poor. Recent studies have demonstrated that use of calcimimetics that reduce PTH secretion by increasing the sensitivity of the parathyroid gland calcium-sensing receptor to circulating calcium allow improved control of serum PTH, calcium, phosphorus and calcium–phosphorus product. This review describes experimental data and the clinical rationale supporting novel strategies for the integration of calcimimetics with conventional therapies to improve control of SHPT.

Key Words: calcium-sensing receptor • chronic kidney disease • cinacalcet • parathyroid hormone • secondary hyperparathyroidism

Received for publication July 17, 2007. Accepted for publication September 10, 2007.


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