title: Advances in pharmacotherapy for secondary hyperparathyroidism.
abstract: BACKGROUND
  Secondary hyperparathyroidism is a frequent complication of chronic kidney disease. This review will discuss the various therapeutic options available for the management of hyperparathyroidism.
  
  
  METHODS
  The main therapeutic strategies available to prevent or slow down the progression of hyperparathyroidism will be detailed here. Reductions in phosphatemia may be achieved by controlling dietary phosphorus, administering phosphorus binders, or increasing the frequency of dialysis sessions. Vitamin D sterols reduce parathyroid hormone (PTH) secretion while normalizing calcium (Ca) and vitamin D levels. Calcimimetics decrease PTH levels, probably with an additional effect on hyperplasia. Percutaneous injections in parathyroids represent an option useful in cases of hyperparathyroidism resistant to pharmacological therapy. Pubmed was searched by combining the terms 'secondary hyperparathyroidism' and the name of each one of the drugs reported in this review.
  
  
  CONCLUSIONS
  PTH increases from early stages of renal disease. One of the goals in pre-dialysis is the prevention of hyperphosphatemia and the maintenance of Ca levels in the normal range. The management of hyperparathyroidism in dialysis requires control of phosphorus level. In this stage, the decision to use calcimimetics and vitamin D derivatives should be made according to serum levels of Ca and phosphorus.
authors.affiliation: Reina Sofía University Hospital/University of Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain Nephrology Service . REDinREN, Madrid , Spain +34 957 213 790 ; +34 957 010 452 ; marianorodriguezportillo@gmail.com.
authors.forename: Mariano
authors.initials: M
authors.lastname: Rodríguez
authors.forename: María E
authors.initials: ME
authors.lastname: Rodríguez-Ortiz
mesh_terms: D057966:Calcimimetic Agents / Q000627:therapeutic use; D002118:Calcium / Q000378:metabolism; D019587:Dietary Supplements; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000188:drug therapy*; D054559:Hyperphosphatemia / Q000188:drug therapy; D010281:Parathyroid Hormone / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use
chemical_list: D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium
keywords: calcimimetic; chronic kidney disease; dialysis; dietary phosphorus restriction; parathyroid injection; phosphorus binder; secondary hyperparathyroidism; vitamin D