skip to content
Dovepress - Open Access to Scientific and Medical Research
View our mobile site

8852

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

Review

(7002) Views  (1592) Full article downloads

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

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








Readers of this article also read:

Management of hyperphosphatemia in patients with end-stage renal disease: focus on lanthanum carbonate
Berberine: metabolic and cardiovascular effects in preclinical and clinical trials
Potential renovascular hypertension, space missions, and the role of magnesium
Critical appraisal of the role of glucosamine and chondroitin in the management of osteoarthritis of the knee
Ego mechanisms of defense are associated with patients’ preference of treatment modality independent of psychological distress in end-stage renal disease
Can a gentamicin-specific chart reduce neonatal medication errors?
Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology
Nephroprotective action of glycosaminoglycans: why the pharmacological properties of sulodexide might be reconsidered
Dashboards in neonatology
Comparison of two treatments for coxarthrosis: local hyperthermia versus radio electric asymmetrical brain stimulation
  • Testimonials

    "You do a tremendous job!!" Ruben Restrepo, The University of Texas Health Science Center at San Antonio