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NDT Plus 2008 1(Supplement 1):i18-i23; doi:10.1093/ndtplus/sfm040
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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

Efficacy of Early Treatment with Calcimimetics in Combination with Reduced Doses of Vitamin D Sterols in Dialysis Patients

David A. Bushinsky1 and Piergiorgio Messa2

1 University of Rochester School of Medicine, Rochester, NY, USA
2 CROFF Policlinico Hospital, Milan, Italy

Correspondence: Piergiorgio Messa, Nephrology Division–CROFF Policlinico di Milano, Via Della Commenda, 20122 Milano, Italy. E-mail: pmessa{at}policlinico.mi.it


  Abstract

Vitamin D is an important physiologic regulator of bone and mineral metabolism. In chronic kidney disease, reduced renal production of calcitriol contributes to secondary hyperparathyroidism (SHPT). Consequently, supplementation with vitamin D sterols is an important treatment for SHPT and its associated mineral and bone disorders. However, doses of vitamin D sterols required to suppress parathyroid hormone (PTH) secretion often promote hypercalcaemia and hyperphosphataemia. Therefore, there is a trade-off between reduced serum PTH and increased levels of serum calcium, phosphorus and calcium–phosphorus product. It has been suggested that treatment of SHPT with cinacalcet, a type II calcimimetic, with reduced doses of vitamin D sterols could enhance achievement of calcium and phosphorus treatment targets while maintaining goals for PTH. Recent clinical trials have evaluated this hypothesis and demonstrated that treatment with cinacalcet in combination with reduced doses of vitamin D sterols is an effective treatment for the management of SHPT.

Key Words: calcimimetics • calcium • parathyroid hormone • phosphorus • secondary hyperparathyroidism • vitamin D

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


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