Achieving therapeutic targets in the treatment of secondary hyperparathyroidism.
Disturbances in the control of extracellular ionized calcium and phosphorus concentrations, and vitamin D metabolism, in patients with chronic kidney disease (CKD) are associated with prolonged stimulation of the parathyroid glands. This results in increased synthesis and release of parathyroid hormone (PTH) and parathyroid hyperplasia-secondary hyperparathyroidism (SHPT). SHPT is in turn a major driver of the skeletal disturbance that characterizes renal osteodystrophy and is associated with vascular and other soft tissue calcification. Current therapeutic strategies based on vitamin D compounds and calcium-containing phosphate binders are difficult to implement effectively because both agents are associated with substantial, and often dose-limiting, calcaemic actions that prevent the attainment of treatment targets. Calcimimetics are novel agents that increase the sensitivity of calcium-sensing receptors in the parathyroid glands. Consequently, they allow simultaneous reduction of both PTH and extracellular calcium concentrations, thus differing from currently available vitamin D therapies. Reduction of the calcium-phosphorus product (Ca x P) is a consistent feature of calcimimetic therapy and may facilitate the achievement of SHPT treatment targets.
Cunningham
John
J
Department of Nephrology, The Middlesex Hospital, University College London Hospitals, Mortimer Street, London W1T 3AA, UK. john.cunningham@uclh.org
D000069449:Cinacalcet; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D009281:Naphthalenes / Q000008:administration & dosage / Q000627:therapeutic use; D010281:Parathyroid Hormone / Q000097:blood; D044169:Receptors, Calcium-Sensing / Q000097:blood / Q000187:drug effects; D014511:Uremia / Q000503:physiopathology
D009281:Naphthalenes; D010281:Parathyroid Hormone; D044169:Receptors, Calcium-Sensing; D000069449:Cinacalcet