title: Therapeutic strategies for secondary hyperparathyroidism in dialysis patients.
abstract: Secondary hyperparathyroidism (SHPT) leads not only to bone disorders, but also to cardiovascular complications in long-term dialysis patients. Conventional treatment with calcium (Ca) supplement, phosphate (P) binders and active vitamin D analogs lead in part to amelioration of SHPT, but are simultaneously associated with unacceptable side-effects, including hypercalcemia, hyperphosphatemia, and increased Ca x P products, which are the risk factors for cardiovascular disease in dialysis patients. Conventional treatment has been unable to facilitate the attainment of optimal management of SHPT proposed in the K/DOQI guidelines. Cinacalcet HCl (cinacalcet), a novel calcimimetic compound, restores the sensitivity of the Ca-sensing receptor in parathyroid cells, and decreases serum parathyroid hormone (PTH) without introducing hypercalcemia or hyperphosphatemia. Cinacalcet treatment enables a significant number of patients to achieve the K/DOQI guideline. Based on experimental data, calcimimetics could ameliorate cardiovascular calcification and remodeling in uremic rats with SHPT. Clinical trials have shown that cinacalcet significantly reduced the risks of parathyroidectomy, fracture and cardiovascular hospitalization among long-term dialysis patients with SHPT. Parathyroid intervention therapy (parathyroidectomy and percutaneous direct injection) is also a useful alternative. In the present article, we review novel therapeutic strategies for SHPT.
authors.affiliation: Department of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan. ogatah@med.show-u.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ogata
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Koiwa
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Ito
authors.forename: Eriko
authors.initials: E
authors.lastname: Kinugasa
mesh_terms: D002118:Calcium / Q000009:adverse effects / Q000627:therapeutic use; D000069449:Cinacalcet; D002986:Clinical Trials as Topic; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications*; D009281:Naphthalenes / Q000627:therapeutic use*; D010710:Phosphates / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*; D014807:Vitamin D / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D009281:Naphthalenes; D010710:Phosphates; D014807:Vitamin D; D002118:Calcium; D000069449:Cinacalcet