Calcimimetics versus vitamin D: what are their relative roles?
A strict control of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) is indicated to avoid serious complications linked to osteitis fibrosa and other parathyroid-hormone (PTH)-related bodily disturbances. However, such a control is often achieved only at the price of unacceptably high plasma calcium and phosphorus levels and the risk of soft tissue calcification, even when using the novel, so-called 'non-hypercalcemic' vitamin D analogs. The advent of a new class of drugs, the calcimimetics, should allow a more adequate control of the disturbed calcium-phosphorus metabolism in CKD patients. In my opinion, the calcimimetics will not replace currently used medications but will be a valuable supplement to presently available treatment options for this major complication in patients with renal failure.
Drüeke
Tilman B
TB
INSERM Unit 507 and Service de Néphrologie, Hôpital Necker, Paris, France. drueke@necker.fr
D002117:Calcitriol / Q000009:adverse effects / Q000031:analogs & derivatives / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D000069449:Cinacalcet; D002986:Clinical Trials as Topic; D004357:Drug Synergism; D004872:Ergocalciferols / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D006887:Hydroxycholecalciferols / Q000009:adverse effects / Q000627:therapeutic use; D006934:Hypercalcemia / Q000139:chemically induced; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000517:prevention & control*; D007408:Intestinal Absorption / Q000187:drug effects; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications*; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D009281:Naphthalenes / Q000493:pharmacokinetics / Q000627:therapeutic use; D010710:Phosphates / Q000097:blood; D018167:Receptors, Calcitriol / Q000187:drug effects / Q000378:metabolism; D044169:Receptors, Calcium-Sensing / Q000819:agonists* / Q000502:physiology; D014807:Vitamin D / Q000009:adverse effects / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000188:drug therapy / Q000209:etiology
D004872:Ergocalciferols; D006887:Hydroxycholecalciferols; D009281:Naphthalenes; D010710:Phosphates; D018167:Receptors, Calcitriol; D044169:Receptors, Calcium-Sensing; D014807:Vitamin D; C042533:1 alpha-hydroxyergocalciferol; C084656:paricalcitol; D002117:Calcitriol; C051883:maxacalcitol; D000069449:Cinacalcet; C008088:alfacalcidol