Pharmacotherapy and interventional treatments for secondary hyperparathyroidism: current therapy and future challenges.
BACKGROUND
Chronic kidney disease is frequently complicated by secondary hyperparathyroidism, which causes bone disease and vascular calcification, leading to increased risk of morbidity and mortality.


METHODS
This review covers treatment options for secondary hyperparathyroidism in patients receiving dialysis, particularly focusing on active vitamin D derivatives, calcimimetics and direct injection therapy into parathyroid glands. In addition, the potential of gene therapy is also described.


RESULTS
The reader will gain a comprehensive review of the effectiveness and role of available therapies for patients with secondary hyperparathyroidism, as well as the results of observational studies that address the effect of these treatments on clinical outcomes.


CONCLUSIONS
Treatment with active vitamin D derivatives and calcimimetics allows adequate control of secondary hyperparathyroidism, which it is hoped will translate into improved clinical outcomes. These treatments appear to be effective even in patients with advanced disease, but patients who develop resistance to therapy should undergo parathyroid intervention, such as surgical parathyroidectomy and direct injection therapy. Gene therapy is not applicable to humans at present, but they will help clarify the molecular pathogenesis of secondary hyperparathyroidism.
Tokai University School of Medicine, Division of Nephrology, Endocrinology and Metabolism, 143 Shimo-Kasuya, Isehara, Japan.
Hirotaka
H
Komaba
Kazuhiro
K
Shiizaki
Masafumi
M
Fukagawa
D000818:Animals; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D000431:Ethanol / Q000008:administration & dosage*; D015316:Genetic Therapy; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology / Q000235:genetics / Q000628:therapy*; D015552:Injections, Intralesional; D007674:Kidney Diseases / Q000150:complications / Q000628:therapy*; D016105:Parathyroidectomy; D006435:Renal Dialysis; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use*
D057966:Calcimimetic Agents; D014807:Vitamin D; D000431:Ethanol