title: Emerging drugs for secondary hyperparathyroidism.
abstract: BACKGROUND
  Secondary hyperparathyroidism (SHPT), a common, serious, and progressive complication of chronic kidney disease (CKD), is characterized by elevated serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and mineral metabolism abnormalities. These disturbances may result in CKD-mineral and bone disorder (CKD-MBD), which is associated with poor quality of life and short life expectancy.
  
  
  METHODS
  The goal of SHPT treatment is to maintain PTH, calcium, and phosphorus within accepted targeted ranges. This review highlights the pathogenesis of SHPT and current SHPT therapeutic approaches, including the use of low-phosphate diets, phosphate binders, 1,25-dihydroxyvitamin D3 (calcitriol) and its analogs, calcimimetics, and parathyroidectomy in addition to discussing emerging drugs in development for SHPT.
  
  
  CONCLUSIONS
  Numerous studies indicate that mineral abnormalities occur early in the course of CKD, are prevalent by the time patients enter dialysis, and foreshadow a risk of cardiovascular and all-cause mortality. Several newly developed compounds may potentially overcome the limitations of current SHPT therapies. If emerging therapies can reduce PTH, normalize mineral metabolism, promote treatment adherence, and reduce the risk of side effects, they may provide the requisite features for improving long-term outcomes in patients with SHPT receiving dialysis and reduce the risks of CKD-MBD.
authors.affiliation: University of Milan, San Paolo Hospital, School of Medicine, Renal Division, Department of Health Sciences , Milan , Italy +39 02 81844381 ; mario.cozzolino@unimi.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: James
authors.initials: J
authors.lastname: Tomlinson
authors.forename: Liron
authors.initials: L
authors.lastname: Walsh
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellasi
mesh_terms: D000818:Animals; D001851:Bone Diseases, Metabolic / Q000209:etiology; D015195:Drug Design; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods
keywords: calcimimetic; chronic kidney disease-mineral and bone disorder; hyperparathyroidism; parathyroid hormone; safety; vitamin D