Document Detail

Treatment of secondary hyperparathyroidism in CKD patients with cinacalcet and/or vitamin D derivatives.
MedLine Citation:
PMID:  19056615     Owner:  NLM     Status:  MEDLINE    
The discovery of the calcium-sensing receptor (CaR) 15 yr ago was rapidly followed by the development of drugs modulating its activity, the so-called calcimimetics (increasing the CaR signal) and calcilytics (decreasing the CaR signal). The indication for calcimimetics is treatment of primary and secondary hyperparathyroidism, whereas calcilytics have potential for treatment of osteoporosis. A large number of clinical studies has shown that cinacalcet, the only presently available calcimimetic, effectively reduces serum parathyroid hormone in dialysis patients with secondary hyperparathyroidism. In contrast to the effect of active vitamin D derivatives, it simultaneously decreases serum calcium and phosphorus. Experimental studies showed a concomitant decrease in parathyroid hyperplasia. In the treatment of secondary hyperparathyroidism of dialysis patients, important questions remain unresolved, for example, whether there are reasons to prefer calcimimetics to active vitamin D derivatives and whether combined administration offers advantages compared with calcimimetics or active vitamin D given in isolation. For lowering parathyroid hormone, available evidence from recent studies suggests that combination therapy should be preferred to single drug treatment because of less side-effects and greater efficacy in controlling parathyroid overfunction. Future randomized controlled trial must answer whether calcimimetics impact on cardiovascular events or survival and whether in this respect there are differences between vitamin D sterols and calcimimetics.
Tilman B Drüeke; Eberhard Ritz
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Publication Detail:
Type:  Journal Article; Review     Date:  2008-12-03
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  4     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-14     Completed Date:  2009-04-10     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  234-41     Citation Subset:  IM    
INSERM Unité 845 and Service de Néphrologie, Hôpital Necker, Tour Lavoisier, Paris Cedex 15, France.
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MeSH Terms
Calcium / blood
Drug Therapy, Combination
Hyperparathyroidism / drug therapy*,  etiology,  metabolism
Kidney Failure, Chronic / complications,  metabolism,  therapy*
Naphthalenes / adverse effects,  therapeutic use*
Parathyroid Hormone / blood
Phosphorus / blood
Receptors, Calcium-Sensing / agonists
Renal Dialysis*
Risk Assessment
Treatment Outcome
Vitamin D / adverse effects,  analogs & derivatives,  therapeutic use*
Reg. No./Substance:
0/Naphthalenes; 0/Parathyroid Hormone; 0/Receptors, Calcium-Sensing; 1406-16-2/Vitamin D; 7440-70-2/Calcium; 7723-14-0/Phosphorus; UAZ6V7728S/cinacalcet

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