The prevention of secondary hyperparathyroidism.

It has become increasingly evident that clear-cut disturbances of bone and mineral metabolism develop early in renal failure. Among these disturbances, hyperparathyroidism is well documented and is usually asymptomatic at that early stage. It is now accepted that early therapy using phosphate restriction, through diet and calcium-containing phosphate binders, and 1 alpha-hydroxylated vitamin D analogues is an effective means of preventing or even reversing hyperparathyroidism in early renal failure. The response to these therapies is both functional (reduced parathyroid hormone secretion) and structural (prevention of parathyroid gland hyperplasia). Parathyroid hyperplasia is largely irreversible; prevention is therefore important and can be achieved initially by a combination of diet and calcium-containing phosphate binders, with later addition of calcitriol or alfacalcidol if parathyroid hormone control cannot be achieved or sustained.