A new paradigm for the treatment of secondary hyperparathyroidism.

The global rise in chronic kidney disease makes secondary hyperparathyroidism (SHPT) a growing medical concern. Conventional therapies for treating SHPT are limited and include calcium-based and calcium-free phosphate binders for reducing serum phosphorus and vitamin D or its analogues for simultaneous stimulation of calcium absorption and suppression of parathyroid hormone (PTH) gene expression. Control of SHPT using these therapies has typically been poor. Recent studies have demonstrated that use of calcimimetics that reduce PTH secretion by increasing the sensitivity of the parathyroid gland calcium-sensing receptor to circulating calcium allow improved control of serum PTH, calcium, phosphorus and calcium-phosphorus product. This review describes experimental data and the clinical rationale supporting novel strategies for the integration of calcimimetics with conventional therapies to improve control of SHPT.