Calcimimetics or vitamin D analogs for suppressing parathyroid hormone in end-stage renal disease

Time for a paradigm shift?

James B. Wetmore, Leigh Quarles

Research output: Contribution to journalReview article

44 Citations (Scopus)

Abstract

Considerable advances have been made in the understanding of the pathogenesis and treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD). These include the discovery that the calcium-sensing receptor has an important role in the regulation of parathyroid gland function, the development of calcimimetics to target this receptor, the recognition that vitamin D receptor activation has important functions beyond the regulation of mineral metabolism, the identification of the phosphaturic factor fibroblast growth factor 23 and the contribution of this hormone to disordered phosphate and vitamin D metabolism in CKD. However, despite the availability of calcimimetics, phosphate binders, and vitamin D analogs, control of SHPT remains suboptimal in many patients with advanced kidney disease. In this Review, we explore several unresolved issues regarding the pathogenesis and treatment of SHPT. Specifically, we examine the significance of elevated circulating fibroblast growth factor 23 levels in CKD, question the proposition that calcitriol deficiency is truly a pathological state, explore the relative importance of the vitamin D receptor and the calcium-sensing receptor in parathyroid gland function and evaluate the evidence to support the treatment of SHPT with calcimimetics and vitamin D analogs. Finally, we propose a novel treatment framework in which calcimimetics are the primary therapy for suppressing parathyroid hormone production in patients with end-stage renal disease.

Original languageEnglish (US)
Pages (from-to)24-33
Number of pages10
JournalNature Clinical Practice Nephrology
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2009

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Parathyroid Hormone
Secondary Hyperparathyroidism
Vitamin D
Chronic Kidney Failure
Chronic Renal Insufficiency
Calcium-Sensing Receptors
Calcitriol Receptors
Parathyroid Glands
Phosphates
Therapeutics
Calcitriol
Kidney Diseases
Minerals
Hormones
fibroblast growth factor 23

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Calcimimetics or vitamin D analogs for suppressing parathyroid hormone in end-stage renal disease : Time for a paradigm shift? / Wetmore, James B.; Quarles, Leigh.

In: Nature Clinical Practice Nephrology, Vol. 5, No. 1, 01.01.2009, p. 24-33.

Research output: Contribution to journalReview article

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