title: Management of secondary hyperparathyroidism in Italy: results of the Italian FARO survey.
abstract: OBJECTIVE
  In recent years, treatment options for secondary hyperparathyroidism (SHPT) have increased (e.g., paricalcitol, calcimimetics). To determine the impact these new treatments have on achieving K/DOQI targets, an observational, prospective survey was undertaken.
  
  
  METHODS
  Four 6-month time-spaced surveys of 2,637 patients in 28 Italian dialysis units were performed. Patient demographic information; use of vitamin D or calcimimetics; and changes in parathyroid hormone (PTH), calcium (Ca) and phosphate (P) levels were evaluated.
  
  
  RESULTS
  Over the course of the survey, use of calcitriol decreased (from 62.1% at baseline to 44.5% at month 18; p<0.001), while use of paricalcitol (from 19.9% to 36.9%; p<0.001) and calcimimetics (from 6.4% to 10.8%; p<0.001) increased. This was associated with a decrease in mean PTH values (from 310.3 ± 292.4 pg/mL at baseline to 279.5 ± 250.1 pg/mL at month 18; p=0.0002), while mean Ca and P remained steady. The percentage of patients achieving K/DOQI ranges for PTH (from 26.8% at baseline to 32.0% at month 18, p<0.001), Ca (from 50.4% at baseline to 55.9% at month 18, p<0.001) and the 3 targets combined (PTH, Ca and P; from 8.8% at baseline to 11.5% at month 18, p=0.003) significantly increased (p<0.05). Despite the introduction of newer agents, two thirds of patients did not achieve target levels.
  
  
  CONCLUSIONS
  Increased awareness and newer treatment options for chronic kidney disease patients with SHPT have changed treatment policy and number of patients achieving K/DOQI target levels in Italy. However, the majority of patients did not meet the target ranges, suggesting that new drugs and strategies are still warranted for optimal management of SHPT in chronic kidney disease.
authors.affiliation: Clinical Science, Sapienza University, Rome, Italy. sandro.mazzaferro@uniroma1.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Mazzaferro
authors.forename: Diego
authors.initials: D
authors.lastname: Brancaccio
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Messa
authors.forename: Vittorio E
authors.initials: VE
authors.lastname: Andreucci
authors.forename: Guido
authors.initials: G
authors.lastname: Bellinghieri
authors.forename: Roberto
authors.initials: R
authors.lastname: Bigazzi
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Bolasco
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Costanzo
authors.forename: Umberto
authors.initials: U
authors.lastname: di Luzio Paparatti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cannella
mesh_terms: D000368:Aged; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D002118:Calcium / Q000097:blood; D002908:Chronic Disease; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use*
chemical_list: D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; D002118:Calcium