title: Management of secondary hyperparathyroidism of dialysis patients.
abstract: Hyperphosphatemia, vitamin D deficiency, and resulted hypocalcemia have been regarded as classical pathogeneses of secondary hyperparathyroidism. These factors have been treated by the administration of phosphorus binder and vitamin D derivatives. However, these therapies have not brought about a successful result for the prevention and treatment of secondary hyperparathyroidism. The reason could be mainly attributed to the hypercalcemia that results from the administration of calcium salts as a phosphorus binder and the calcemic action of vitamin D. To prevent hypercalcemia, non-calcium containing phosphorus binder (sevelamer hydrochloride) and vitamin D analogues, which suppress PTH secretion with minimum calcemic action, have been developed. These new vitamin D analogues include 19-nor-1-alpha, 25-dihydroxyvitamin D2 (paricalcitol), 1-alpha-hydroxyvitamin D2 (doxercalciferol), 22oxa-calcitriol (maxacalcitol) and F6-calcitriol (falecalcitriol). Furthermore, calcimimetics that stimulate calcium-sensing receptor of parathyroid cells as calcium and suppress PTH secretion are now under clinical trial. Percutaneous direct injection therapy of vitamin D, vitamin D analogue or calcimimetics into parathyroid gland has also been reported. The combination of these new strategies is expected to effectively and safely suppresses secondary hyperparathyroidism that has been resistant to conventional medical treatments.
authors.affiliation: Center of Blood Purification Therapy, Wakayama Medical University, Internal Medicine, Showa University Northern Yokohama Hospital, Japan. akizawa@wakayama-med.ac.jp
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kamimura
authors.forename: Masahide
authors.initials: M
authors.lastname: Mizobuchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shiizaki
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: D000431:Ethanol / Q000008:administration & dosage; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007267:Injections; D010280:Parathyroid Glands; D016105:Parathyroidectomy; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D000431:Ethanol