title: Safety and tolerability of paricalcitol in patients with chronic kidney disease.
abstract: BACKGROUND
  Secondary hyperparathyroidism (SHPT) is a complication of chronic kidney disease (CKD). Beyond skeletal complications, uncontrolled SHPT is associated with cardiovascular mortality. Vitamin D receptor activators (VDRAs) are a mainstay of therapy for SHPT; however, use is limited by hypercalcemia, though less so with calcitriol analogs such as paricalcitol and there is emerging experience with oral formulations for non-SHPT indications. The role of VDRAs in the treatment of SHPT becomes a complex question as alternative strategies have developed.
  
  
  METHODS
  This review summarizes trials that established the safety and efficacy of paricalcitol for SHPT. Comparative experience with paricalcitol as against other VDRAs will be reviewed as will the experience with paricalcitol in non-dialysis CKD and comparative experience with non-VDRA-based therapy.
  
  
  CONCLUSIONS
  VDRA therapy is considered first-line therapy for treatment of SHPT. Paricalcitol has demonstrated superiority to calcitriol with respect to parathyroid hormone suppression and calcium-phosphorus balance. Oral formulations of paricalcitol appear to be similarly effective for SHPT. While there is evidence to suggest adjunctive antiproteinuria benefit with the use of VDRAs, efficacy of these agents to slow the progression of CKD or to reduce cardiovascular risk has not yet been demonstrated.
authors.affiliation: University of Texas Health Science Center San Antonio, Medicine/Nephrology, South Texas Veterans Health Care System, 7703 Floyd Curl Dr, MC 7882, San Antonio 78229, USA. DyerCA@uthscsa.edu
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Dyer
mesh_terms: D004872:Ergocalciferols / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism; D018167:Receptors, Calcitriol / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*
chemical_list: D004872:Ergocalciferols; D018167:Receptors, Calcitriol; C084656:paricalcitol