[Kidney and bone update : the 5-year history and future of CKD-MBD. Parathyroidectomy for secondary hyperparathyroidism].

Induction of Cinacalcet HCl (cinacalcet) has influenced treatment of secondary hyperparathyroidism (SHPT) in Japan. The number of parathyroidectomy (PTx) for SHPT has remarkably decreased. Fundamentally patients with advanced SHPT refractory to medical treatment including cinacalcet should require PTx. PTx can release SHPT most dramatically. Because in Japan, many hemodialysis patients are expected for long-term survival, we should decide the indication of PTx concerning long-term treatment and economical aspect. We recommend PTx for patients who are expected for long term survival and SHPT is resistant to vitamin D activators, patients with severe symptoms of SHPT, patients with SHPT resistant to cinacalcet, patients with hypercalcemia and/or hyperphosphatemia resistant to medical treatment, and patients who cannot tolerate to side effect of cinacalcet. Some patients with advanced SHPT which is not controlled by surgical treatment should require cinacalcet therapy as rescuing treatment before operation.