Back to Browse Journals » International Journal of Nephrology and Renovascular Disease » Volume 1

Treatment of secondary hyperparathyroidism in kidney disease: what we know and do not know about use of calcimimetics and vitamin D analogs

Authors James B Wetmore, L Darryl Quarles

Published Date November 2008 Volume 2008:1 Pages 5—17

DOI http://dx.doi.org/10.2147/IJNRD.S4368

Published 13 November 2008

James B Wetmore1, L Darryl Quarles1,2

1Department of Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS, USA; 2The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA

Abstract: There is a growing understanding of the pathophysiology of secondary hyperparathyroidism (SHPT) and a recent emergence of new agents for SHPT treatment in patients with advanced kidney disease. At the same time, appreciation that mineral metabolic derangements promote vascular calcification and contribute to excess mortality, along with recognition of potentially important “non-classical” actions of vitamin D, have prompted the nephrology community to reexamine the use of various SHPT treatments, such as activated vitamin D sterols, phosphate binders, and calcimimetics. In this review, the evidence for treatment of SHPT with calcimimetics and vitamin D analogs is evaluated, with particular consideration given to recent clinical trials that have reported encouraging findings with cinacalcet use. Additionally, several controversies in the pathogenesis and treatment of SHPT are explored. The proposition that calcitriol deficiency is a true pathological state is challenged, the relative importance of the vitamin D receptor and the calcium sensing receptor in parathyroid gland function is summarized, and the potential relevance of non-classical actions of vitamin D for patients with advanced renal disease is examined. Taken collectively, the balance of evidence now supports a treatment paradigm in which calcimimetics are the most appropriate primary treatment for SHPT in the majority of end stage renal disease patients, but which nevertheless acknowledges an important role for modest doses of activated vitamin D sterols.

Keywords: secondary hyperparathyroidism, vitamin D, vitamin D receptor, calcium sensing receptor, calcimimetics, kidney disease

Download Article [PDF] 

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php

Readers of this article also read:

Enhanced photodynamic leishmanicidal activity of hydrophobic zinc phthalocyanine within archaeolipids containing liposomes [Corrigendum]

Perez AP, Casasco A, Schilrreff P, Defain Tesoriero MV, Duempelmann L, Pappalardo JS, Altube MJ, Higa L, Morilla MJ, Petray P, Romero EL

International Journal of Nanomedicine 2015, 10:169-170

Published Date: 29 December 2014

Disease burden and patient reported outcomes among patients with moderate to severe psoriasis: an ethnography study

Narayanan S, Guyatt V, Franceschetti A, Hautamaki EL

Psoriasis: Targets and Therapy 2015, 5:1-7

Published Date: 23 December 2014

Lumbosacral plexus delineation, dose distribution, and its correlation with radiation-induced lumbosacral plexopathy in cervical cancer patients

Tunio M, Al Asiri M, Bayoumi Y, Abdullah O Balbaid A, AlHameed M, Gabriela SL, Amir O Ali A

OncoTargets and Therapy 2015, 8:21-27

Published Date: 23 December 2014

Further data on the association between Helicobacter pylori infection and primary open-angle glaucoma

Zavos C, Kountouras J

Clinical Ophthalmology 2012, 6:243-245

Published Date: 10 February 2012

An analysis of the Bateson Review of research using nonhuman primates

Greek R, Hansen LA, Menache A

Medicolegal and Bioethics 2011, 1:3-22

Published Date: 6 December 2011

Eggshell membrane: A possible new natural therapeutic for joint and connective tissue disorders. Results from two open-label human clinical studies

Kevin J Ruff, Dale P DeVore, Michael D Leu, Mark A Robinson

Clinical Interventions in Aging 2009, 4:235-240

Published Date: 18 May 2009