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NDT Plus 2008 1(Supplement 1):i12-i17; doi:10.1093/ndtplus/sfm039
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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

Secondary Hyperparathyroidism Disease Stabilization Following Calcimimetic Therapy

João Frazão1 and Mariano Rodriguez2

1 Nephrology Research and Development Unit and School of Medicine, University of Porto, Porto, Portugal
2 Unidad de Investigacion, Servicio de Nefrologia, Hospital Universitario, Reina Sofia, Cordoba, Spain

Correspondence: João Frazão, Nephrology Department, Hospital de S João and School of Medicine, University of Porto, Porto, Portugal. E-mail: jmmdfrazao{at}netcabo.pt


  Abstract

Standard therapy for secondary hyperparathyroidism (SHPT) includes dietary calcium supplementation, active vitamin D, and phosphate binders; however, these are often insufficient to allow patients to achieve their serum parathyroid hormone (PTH), calcium and calcium–phosphorus product (Ca x P) targets. Recent preclinical studies have demonstrated that treatment with type II calcimimetics that increase the sensitivity of the calcium-sensing receptor (CaR) to calcium can reverse the alterations in CaR and vitamin D receptor expression and parathyroid cell proliferation that are associated with SHPT. These data suggest that calcimimetic treatment could stabilize disease progression and improve maintenance of treatment goals. In clinical trials involving SHPT patients, the calcimimetic cinacalcet has been shown to decrease PTH, calcium, phosphorus and Ca x P. Significant improvements were seen regardless of initial disease severity, and benefits were maintained over the course of long-term therapy (up to 4 years), indicating effective disease stabilization. In conclusion, preclinical and clinical data provide both theoretical and empirical support for the use of calcimimetics in moderate and advanced SHPT to effectively stabilize disease.

Key Words: calcimimetic • calcium-sensing receptor • cinacalcet • secondary hyperparathyroidism

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


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