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Calcimimetics or vitamin D analogs for suppressing parathyroid hormone in end-stage renal disease: time for a paradigm shift?
Nat Clin Pract Nephrol. 2009 Jan; 5(1):24-33.NC

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.

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Authors+Show Affiliations

Wetmore JB
Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS 66160, USA.
Quarles LD
No affiliation info available

MeSH

HumansHyperparathyroidism, SecondaryKidney Failure, ChronicNaphthalenesParathyroid HormoneVitamin D

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18957950

Citation

Wetmore, James B., and L Darryl Quarles. "Calcimimetics or Vitamin D Analogs for Suppressing Parathyroid Hormone in End-stage Renal Disease: Time for a Paradigm Shift?" Nature Clinical Practice. Nephrology, vol. 5, no. 1, 2009, pp. 24-33.
Wetmore JB, Quarles LD. Calcimimetics or vitamin D analogs for suppressing parathyroid hormone in end-stage renal disease: time for a paradigm shift? Nat Clin Pract Nephrol. 2009;5(1):24-33.
Wetmore, J. B., & Quarles, L. D. (2009). Calcimimetics or vitamin D analogs for suppressing parathyroid hormone in end-stage renal disease: time for a paradigm shift? Nature Clinical Practice. Nephrology, 5(1), 24-33. https://doi.org/10.1038/ncpneph0977
Wetmore JB, Quarles LD. Calcimimetics or Vitamin D Analogs for Suppressing Parathyroid Hormone in End-stage Renal Disease: Time for a Paradigm Shift. Nat Clin Pract Nephrol. 2009;5(1):24-33. PubMed PMID: 18957950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Calcimimetics or vitamin D analogs for suppressing parathyroid hormone in end-stage renal disease: time for a paradigm shift? AU - Wetmore,James B, AU - Quarles,L Darryl, Y1 - 2008/10/28/ PY - 2008/06/03/received PY - 2008/09/09/accepted PY - 2008/10/30/pubmed PY - 2009/4/7/medline PY - 2008/10/30/entrez SP - 24 EP - 33 JF - Nature clinical practice. Nephrology JO - Nat Clin Pract Nephrol VL - 5 IS - 1 N2 - 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. SN - 1745-8331 UR - https://www.unboundmedicine.com/medline/citation/18957950/full_citation DB - PRIME DP - Unbound Medicine ER -