title: New strategies for the treatment of secondary hyperparathyroidism.
abstract: Classic pathogeneses of secondary hyperparathyroidism (2HPT), hyperphosphatemia, vitamin D deficiency, and hypocalcemia, have been treated by the administration of phosphorus binders and vitamin D derivatives. However, these therapies have not brought about a successful result. The main reason could be attributed to hypercalcemia resulting from the administration of calcium salts as a phosphorus binder and the calcemic action of vitamin D. To prevent hypercalcemia, non-calcium-containing phosphorus binders and vitamin D analogues, which suppress parathyroid hormone (PTH) secretion with minimum calcemic action, have been developed. Furthermore, calcimimetics that stimulate the calcium-sensing receptor of parathyroid cells and suppress PTH secretion are now under clinical trial. Direct injection therapy of vitamin D analogues or calcimimetics into the parathyroid gland also has been reported. These new strategies are expected to effectively and safely suppress 2HPT, which has been resistant to conventional medical treatments.
authors.affiliation: Center of Blood Purification Therapy, First Department of Pathology, Wakayama Medical University, Wakayama, Japan. akizawa@wakayama-med.ac.jp
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shiizaki
authors.forename: Ikuji
authors.initials: I
authors.lastname: Hatamura
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kamimura
authors.forename: Masahide
authors.initials: M
authors.lastname: Mizobuchi
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Narukawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Sumikado
authors.forename: Toshibumi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shigeo
authors.initials: S
authors.lastname: Negi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ogata
authors.forename: Eriko
authors.initials: E
authors.lastname: Kinugasa
mesh_terms: D000818:Animals; D004852:Epoxy Compounds / Q000627:therapeutic use; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy* / Q000209:etiology; D010758:Phosphorus / Q000378:metabolism; D011073:Polyamines; D011095:Polyethylenes / Q000627:therapeutic use; D000069603:Sevelamer; D014807:Vitamin D / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D004852:Epoxy Compounds; D011073:Polyamines; D011095:Polyethylenes; D014807:Vitamin D; D010758:Phosphorus; D000069603:Sevelamer