title: Does it matter how parathyroid hormone levels are suppressed in secondary hyperparathyroidism?
abstract: Because secondary hyperparathyroidism is associated with morbidity and mortality in patients with chronic kidney disease, suppression of parathyroid hormone (PTH) and minimization of associated derangements in mineral metabolism are cardinal therapeutic goals. There is an ongoing debate regarding the proper treatment strategy for PTH suppression in this population. While some practitioners believe that calcitriol analogues should be the primary therapy in this setting, others contend that calcimimetics offer unique treatment benefits. Recent advancements in the understanding of the pathophysiology of secondary hyperparathyroidism and the secondary effects of these agents may help clarify this debate. Here, we review the classical actions of calcitriol analogues and calcimimetics on mineral metabolism. We also examine the potential nonclassical effects of these therapies on the renin-angiotensin-aldosterone system, proteinuria, vascular calcification, fibroblast growth factor-23, inflammation, and overall survival.
authors.affiliation: Division of Nephrology and Hypertension and The Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA. jstubbs@kumc.edu
authors.forename: Jason R
authors.initials: JR
authors.lastname: Stubbs
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
mesh_terms: D000818:Animals; D057966:Calcimimetic Agents / Q000627:therapeutic use*; D002114:Calcinosis; D002117:Calcitriol / Q000031:analogs & derivatives*; D002118:Calcium / Q000378:metabolism; D000069449:Cinacalcet; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy*; D054559:Hyperphosphatemia / Q000139:chemically induced; D006965:Hyperplasia / Q000188:drug therapy; D006996:Hypocalcemia / Q000139:chemically induced; D007674:Kidney Diseases / Q000503:physiopathology; D009281:Naphthalenes / Q000627:therapeutic use; D010280:Parathyroid Glands / Q000473:pathology / Q000502:physiology; D010281:Parathyroid Hormone / Q000097:blood*; D010710:Phosphates / Q000378:metabolism; D011507:Proteinuria / Q000188:drug therapy; D006435:Renal Dialysis; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D057966:Calcimimetic Agents; D009281:Naphthalenes; D010281:Parathyroid Hormone; D010710:Phosphates; D002117:Calcitriol; D002118:Calcium; D000069449:Cinacalcet