Treatment of Secondary Hyperparathyroidism in CKD Patients with Cinacalcet and/or Vitamin D Derivatives

Abstract

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.

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

“…In all others, active vitamin D, cinacalcet and PTX can be used sequentially. However, cinacalcet is not a cost-effective treatment for patients with sHPT because of its high cost (13,14). Unfortunately, during our study period (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011), no calcimimetics were available in our country.…”

“…In the preoperative course, identifying the localization of hyperplasic glands with 99m Tec sestamibi and ultrasonography may be insufficient (12)(13)(14)(15). The presence of aberrant localization or an ectopic gland observed through scintigraphy may affect the success of the exploration (16).…”

Abnormal Renal Function and Electrolyte Disturbances in Older People

“…17,18 Cinacalcet Cinacalcet (Sensipar) mimics calcium binding at the calcium receptor on parathyroid glands and reduces parathyroid hormone levels. 13 Cinacalcet can severely reduce serum calcium levels giving rise to symptomatic hypocalcaemia. Monitoring calcium and parathyroid hormone levels in patients taking cinacalcet is vital.…”

A mathematical model of calcium and phosphorus metabolism in two forms of hyperparathyroidism

“…Furthermore, we examined potential effects of the administration of calcimimetics to patients with hyperparathyroidism. Calcimimetics is a recently developed class of drugs, which is considered to modulate the action of calcium-sensing receptors [14,15]. These calcium-sensing receptors are located not only in the parathyroid gland but also in the intestine and the kidney tubule [16].…”