Clinical analysis on 50 chroic kidney disease patients complicated with secondary hyperparathyroidism

目的 探讨慢性肾脏病(CKD)合并继发性甲状旁腺功能亢进症(SHPT)患者血清甲状旁腺激素( PTH)、钙磷水平的变化及其治疗对策.方法 50例CKD合并SHPT患者随机分为治疗组(30例)和对照组(20例),对照组采用常规治疗,治疗组在对照组基础上加用骨化三醇、磷结合剂及低钙透析液治疗.检测两组血清PTH、血清碱性磷酸酶(ALP)、血清钙、磷浓度,计算钙磷乘积.结果 与对照组和治疗前相比,治疗组治疗期间的PTH、ALP水平和钙磷乘积下降(P＜0.05),治疗20周后心血管疾患、感染、肾性骨病、贫血等并发症减少(P＜0.05).结论 积极调整CKD患者钙磷代谢及血清PTH、ALP水平,对减少CKD患者并发症有重要意义.     

活性维生素D及磷结合剂加用盐酸西那卡塞治疗慢性肾衰竭透析患者继发甲状旁腺功能亢进的临床疗效

目的探讨活性维生素D和磷结合剂加用盐酸西那卡塞治疗慢性肾衰竭(CRF)透析患者继发甲状旁腺功能亢进(SHPT)的临床疗效。方法选取2013年1月—2015年1月在涞源县医院进行血液透析的CRF继发SHPT患者65例,随机分为对照组35例和观察组30例。两组患者每周进行3次血液透析,并口服碳酸钙1.5g/d,每次透析后当晚服用骨化三醇胶丸2.0μg。观察组患者另加用盐酸西那卡塞片治疗,起始剂量为25mg/d,根据血钙、血磷等检测结果,逐渐调整剂量至75mg/d。均治疗6个月。比较两组患者治疗前及治疗6个月后的血钙、血磷、全段甲状旁腺激素(i PTH)水平及钙磷乘积。结果治疗前两组患者血钙、血磷、i PTH水平及钙磷乘积比较,差异无统计学意义(P>0.05);治疗后观察组患者血钙、血磷、i PTH水平及钙磷乘积低于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论活性维生素D及磷结合剂的基础上加用盐酸西那卡塞治疗,可以进一步降低慢性肾脏病透析SHPT患者血钙、血磷、i PTH水平及钙磷乘积。     

阿法骨化醇冲击或每日治疗对继发性甲状旁腺功能亢进患者血钙血磷水平的影响

目的:观察阿法骨化醇(1α-(OH)-D3)冲击治疗和每日治疗对慢性肾脏病尿毒症期维持血液透析后继发性甲状旁腺功能亢进(SHPT)患者的血钙血磷水平的影响。方法:选取SHPT的尿毒症血液透析患者56例,随机均分成常规组和冲击组。常规组口服阿法骨化醇0.75μg·d-1;冲击组口服阿法骨化醇每次3μg,每周2次。2组均治疗12周。在治疗前及治疗后第4、8、12周时测2组患者血清钙、磷、钙磷乘积、碱性磷酸酶(ALP)及血全段甲状旁腺激素(iPTH)水平,并观察不良反应。结果:2组患者血钙水平均较治疗前显著上升(P<0.05),但2组治疗同期比较差异无统计学意义(P>0.05);2组血磷水平治疗前、后及组间比较,差异均无统计学意义(P>0.05);常规组钙磷乘积治疗第4、8周时较治疗前显著上升(P<0.05),但冲击组上升不明显(P>0.05),且治疗第4、8周时,常规组的钙磷乘积显著高于冲击组,差异有统计学意义(P<0.05);2组iPTH、ALP水平治疗第4、8、12周时均显著低于治疗前(P<0.05)。2组不良反应均较轻微,且差异无统计学意义(P>0.05)。结论:阿法骨化醇口服常规治疗和冲击治疗均能控制SHPT,但冲击治疗效果更明显,且起效快。     

观察骨化三醇对尿毒症继发性甲状旁腺功能亢进症远期疗效

目的 观察骨化三醇对尿毒症维持性血透(MHD)患者继发性甲状旁腺功能亢进症(SHPT)的远期疗效。方法 血透的26例尿毒症合并SHPT患者随机分成冲击治疗组和常规治疗组,各13例。常规治疗组给予骨化三醇0.25~0.50μg治疗;冲击治疗组根据i PTH水平给予不同剂量的骨化三醇治疗。观察两组患者治疗前、后甲状旁腺激素、血钙、血磷及钙磷乘积和患者临床症状的变化。结果 两组总有效率无明显差别(P>0.05);治疗后两组患者i PTH均明显下降(P<0.05);常规治疗组Ca、P及Ca×P水平与治疗前比较无明显差别(P>0.05);冲击治疗组Ca、Ca×P水平与治疗前比较升高(P<0.05),血P水平无明显变化(P>0.05);冲击治疗组患者i PTH、P与常规治疗组比较无明显差别(P>0.05),而血Ca、Ca×P水平比常规治疗组明显升高(P<0.05)。结论 维持性血透伴继发性甲状旁腺功能亢进症的尿毒症患者应用骨化三醇治疗,无论应用常规剂量持续给药或是冲击治疗方案,36个月后少数患者无效,大部分患者效果明显,两种治疗方法长期疗效无明显区别,但冲击治疗组患者血钙及钙磷乘积高于常规剂量治疗组。     

帕立骨化醇对血液透析伴继发性甲状旁腺功能亢进患者炎症及贫血的影响

目的：探讨帕立骨化醇在维持性血液透析(MHD)伴有继发性甲状旁腺功能亢进(SHPT)患者中改善炎症状态和贫血的作用。方法：选取MHD伴有SHPT患者116例,按照治疗方法的不同,分为观察组和对照组,观察组76例,使用帕立骨化醇治疗;对照组40例,使用骨化三醇治疗。检测两组患者治疗前后的钙磷水平、中性粒细胞淋巴细胞比值(NLR)、甲状旁腺素(PTH)以及血红蛋白、C反应蛋白(CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)。结果：观察组治疗1,2,3,4,5,6个月后,患者血钙水平较治疗前升高(P<0.05),但血钙水平均数<2.5 mmol/L;血磷水平、钙磷乘积和PTH水平均下降,差异有统计学意义(P<0.05);治疗3个月和6个月后血红蛋白上升,炎症指标CRP,NLR,IL-6,TNF-α均下降(P<0.05)。观察组效果优于对照组。结论：帕立骨化醇有效治疗SHPT的同时,对MHD患者的炎症及贫血均具有改善作用。     

西那卡塞治疗肾性继发性甲状旁腺功能亢进的临床疗效

目的观察西那卡塞治疗肾性继发性甲状旁腺功能亢进(SHPT)患者的临床疗效。方法肾性SHPT患者60例分为两组,每组30例。西那卡塞组:西那卡塞起始剂量25 mg·d~(-1),每3周调整一次剂量,最大剂量100 mg·d~(-1);骨化三醇0.25μg,qn。对照组:骨化三醇每次2μg,每周2次,静脉或口服均可。疗程均为6个月。治疗期间每月监测患者血常规和血钙、磷和全段甲状旁腺激素(iPTH)水平,并记录不良反应发生情况。结果西那卡塞组完成28例,对照组患者均完成试验。治疗6个月,西那卡塞组和对照组i PTH达标率分别为82%和37%(P<0.01),血钙达标率分别为100%和43%(P<0.01),血磷达标率分别为50%和10%(P<0.01)。与治疗前比较,西那卡塞组血钙、磷和钙磷乘积均显著降低(P<0.01),而对照组血钙、磷、钙磷乘积均上升(P<0.01),组间差异非常显著(P<0.01)。西那卡塞组和对照组血i PTH均下降(P<0.01),西那卡塞组下降幅度大于对照组(P<0.01)。西那卡塞组有1例患者出现消化道症状不良反应,对照组无不良反应发生。结论与骨化三醇冲击疗法相比,西那卡塞降低SHPT患者i PTH水平更明显,同时具有降低血钙、磷、钙磷乘积的作用,且安全性较好。     

低钙透析联合骨化三醇冲击治疗继发性甲状旁腺功能亢进症的临床观察

目的探讨低钙透析骨化三醇冲击治疗慢性肾衰竭并发继发性甲状旁腺功能亢进症(SHPT)患者的临床疗效。方法将40例慢性肾衰竭并发SHPT患者随机分为联合组与对照组。对照组给予常规透析和骨化三醇冲击治疗,联合组给予低钙透析和骨化三醇冲击治疗。结果 (1)两组血甲状旁腺激素(PTH)水平在治疗第4、8、12周时均较治疗前显著降低(P<0.05),且组间同期比较,差异无统计学意义(P>0.05);(2)对照组血钙水平在治疗第4、8、12周时均较治疗前显著升高(P<0.05),且明显高于同期联合组(P<0.05),而联合组在治疗第4、8、12周与治疗前比较,差异无统计学意义(P>0.05);(3)两组血磷水平在治疗第4、8、12周时均较治疗前显著降低(P<0.05),且组间同期比较,差异无统计学意义(P>0.05)。结论低钙透析联合骨化三醇冲击治疗慢性肾衰竭并发SHPT,有效降低了PTH水平,而且也能有效纠正钙、磷紊乱,使之维持正常的平衡,值得临床推广应用。     

西那卡塞片联合阿法骨化醇软胶囊治疗血液透析合并继发性甲状旁腺功能亢进的疗效观察

目的 观察西那卡塞片联合阿法骨化醇软胶囊治疗维持性血液透析(Hemodialysis, HD)合并继发性甲状旁腺功能亢进(Secondary hyperparathyroidism, SHPT)的疗效。方法 选择2020年1月至2022年8月本院血液净化中心行维持性HD同时伴有SHPT患者39例作为治疗组,给予西那卡塞片联合阿法骨化醇软胶囊治疗。选择同期HD合并SHPT患者34例作为对照组,给予HD治疗。比较两组白细胞计数、血红蛋白、血白蛋白、肾脏功能、碱性磷酸酶(Alkaline phosphatase, ALP)、血脂、校正血钙、血磷、血镁、全段甲状旁腺激素(intact Parathyroid hormone, iPTH)和C反应蛋白等指标。结果 治疗组ALP、iPTH水平低于对照组,血红蛋白水平高于对照组(P<0.05),而血钙和血磷水平差异无统计学意义(P>0.05)。结论 西那卡塞片联合阿法骨化醇软胶囊可有效降低维持性HD合并SHPT患者的ALP、iPTH水平,提高血红蛋白水平,且对血钙、血磷的水平无明显影响。     

氨基酸鳌合钙联合骨化三醇治疗肾性骨病的临床观察

目的:探讨治疗继发性甲状旁腺功能亢进(SHPT)骨病的方法.方法:对48例长期血液透析的慢性肾功能衰竭患者分别给予骨化三醇及骨化三醇联合钙剂治疗,观察血清钙、磷、钙磷乘积、甲状旁腺激素(PTH)水平变化,并对两种治疗方法的结果进行比较.结果:两种治疗均可显著增加血清钙水平,降低血清磷水平,骨化三醇加钙剂治疗的疗效更为显著(P＜0.01).结论:钙荆加骨化三醇治疗SHPT骨病优于单用骨化三醇.     

碳酸钙治疗慢性肾病患者早期钙磷代谢紊乱的疗效观察

目的观察碳酸钙治疗慢性肾病(CKD)早期钙磷代谢紊乱的疗效。方法将存在钙磷紊乱的67例CKDⅢ~Ⅳ期的患者服用碳酸钙8周,观察治疗前后血钙、磷、甲状旁腺激素(iPTH)、碱性磷酸酶(AKP)、血肌酐的变化。结果治疗后血钙明显升高(P<0.05),血磷明显下降(P<0.05),iPTH明显下降(P<0.05)。结论碳酸钙可以作为CKD早期SHPT的常规治疗。     

维持性血液透析患者钙磷代谢紊乱分析

目的分析维持性血液透析患者钙磷代谢紊乱情况。方法对70例维持性血液透析患者的钙、磷浓度、钙磷浓度乘积及甲状旁腺素（PTH）进行测定,并与K／DOQI指南指标进行比较。结果70例患者中,≥50岁36例,〈50岁34例,两组血清钙、磷浓度及钙磷乘积、PTH水平比较,差异均无统计学意义（均P〉0．05）;透析时间越长,患者血清磷、PTH水平改变越明显,差异有统计学意义（均P〈0．05）;70例中有46例（65．7％）血清钙、34例（48．6％）血清磷、40例（57．1％）钙磷乘积、28例（40％）PTH浓度达到K／DOQI指南要求,仅有18例（25．7％）患者所有指标达到K／DOQI要求。结论多数血液透析患者钙磷代谢控制仍然达不到K／DOQI要求的目标。     

碳酸镧联合醋酸钙对维持性血液透析患者钙磷矫正浓度、血管钙化及甲状旁腺功能的影响

目的 探讨碳酸镧咀嚼片联合醋酸钙片对维持性血液透析（MHD）患者血钙矫正浓度、血磷浓度、钙磷乘 积、血管钙化情况及甲状旁腺功能的影响。方法 选取2017年9月—2018年9月本院收治的90例MHD患者作为受 试对象,根据随机数字表法分为对照组45例和研究组45例。对照组口服醋酸钙片治疗,研究组在对照组基础上口 服碳酸镧咀嚼片治疗,2组均连续治疗12周。评价临床疗效,比较治疗前后2组血钙矫正浓度、血磷浓度、钙磷乘积、 冠脉钙化积分（CACS）及血清甲状旁腺激素（PTH）等浓度。结果 治疗后,研究组总有效率显著高于对照组 （93.33% vs. 75.56%,P＜0.05）。治疗后2组患者血钙矫正浓度均显著高于治疗前,血磷浓度及钙磷乘积均明显低于 治疗前（P＜0.05）,且治疗后研究组血钙矫正浓度、血磷浓度及钙磷乘积均明显低于对照组（P＜0.05）。治疗后2组 患者CACS、血清PTH浓度均显著低于治疗前,且研究组患者CACS、血清PTH浓度明显低于对照组（P＜0.05）。2组 患者药物不良反应发生率差异无统计学意义（P＞0.05）。结论 碳酸镧咀嚼片和醋酸钙片联合治疗效果好,不仅能 有效纠正MHD患者钙、磷代谢异常,延缓血管钙化进展,还可明显改善甲状旁腺功能。     

长期血透患者甲状旁腺素测定的临床意义

目的　探讨检测长期血透患者甲状旁腺素对继发性甲状旁腺功能亢进的早期诊断、预防和治疗的临床意义。方法　选择 84例长期血液透析患者 ,分为服钙剂组与不服钙剂组 ,另选择 30例非肾功能减退患者为正常对照组 ,分别检测患者血清甲状旁腺素、钙、磷、尿素氮、肌酐等。结果　服钙剂组患者血清甲状旁腺素、磷明显低于不服钙剂组 ,两者之间有显著性差异 (P<0 .0 5) ;而两组患者间的血清钙没有显著性差异 (P>0 .0 5) ;长期血透患者的血清甲状旁腺素明显大于正常对照组 ,与尿素氮、肌酐和磷呈正相关。结论　甲状旁腺素检测对长期血透患者继发甲状旁腺功能亢进的早期诊断、预防和治疗有重要指导意义 ;服用钙剂能预防和治疗继发性甲状旁腺功能亢进 ,减少继发性甲状旁腺功能亢进的发生率     

α-酮酸联合碳酸钙改善维持性血液透析患者钙磷代谢的疗效观察

目的探究α-酮酸联合碳酸钙改善维持性血液透析患者钙磷代谢的临床疗效。方法选取2015年1月—2015年7月在崇州市人民医院进行维持性血液透析治疗的患者82例,随机分为对照组与治疗组,每组各41例。对照组患者口服碳酸钙D3片,600 mg/次,2次/d。治疗组在对照组基础上,餐中口服复方α-酮酸片,4片/次,3次/d。两组的治疗时间不低于6个月。分析两组患者治疗前、治疗后3、6个月血液中钙磷的量、钙磷乘积、血清中碱性磷酸酶(AKP)、甲状旁腺激素(PTH)水平、血白蛋白含量、综合性营养评估(SGA)及BMI指数的变化情况。结果治疗后3、6个月,两组患者的血磷量和钙磷乘积明显降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组的降低程度优于对照组(P0.05)。治疗后3、6个月,两组PTH值均降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组的PTH值显著低于同期对照组,两组比较差异具有统计学意义(P0.05)。治疗后3、6个月,两组血白蛋白量、SGA评分、BMI指数均得到改善,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标显著优于同期对照组,两组比较差异具有统计学意义(P0.05)。结论复方α-酮酸联合碳酸钙能明显改善维持性血液透析患者的钙磷代谢情况,提高患者的营养状况,可有效的预防并发症发生。     

Graves病患者骨代谢指标的变化

【摘要】目的 观察Graves病患者血中钙、磷、碱性磷酸酶（ALP）、甲状旁腺素（PTH）和25羟维生素D[25（OH） D]水平变化及在骨代谢中的作用。方法 收集62例初发或复发的Graves病患者及91例正常对照人群资料。电化学发光法测定血浆PTH和25（OH）D;生化法测定血钙、磷、ALP。结果 Graves病组血钙、磷、ALP、25（OH）D水平升高, PTH降低（均P＜0.01）。亚组分析显示,女性患者血钙、磷、ALP、25（OH）D水平高于对照组,PTH水平低于对照组;男性患者ALP、25（OH）D水平高于对照组,PTH水平低于对照组（均P＜0.01）。Graves病组维生素D缺乏17例（27.4%）,不足20例（32.3%）,充足25例（40.3%）;对照组维生素D缺乏54例（59.3%）,不足31例（34.1%）,充足6例（6.6%）。Graves病组血PTH、血25（OH）D、血钙及血磷无相关性。结论 Graves病骨转换加速,患者血25（OH）D水平升高,可能与高血钙、血PTH降低、高血磷导致1-α-羟化酶活性降低有关。维生素D缺乏在Graves病骨代谢中的作用不大。     

腹膜透析患者血清基质金属蛋白酶水平变化的意义

目的 了解维持性腹膜透析(CAPD)患者血清基质金属蛋白酶-10(MMP-10)、基质金属蛋白酶-8(MMP-8)、基质金属蛋白酶组织抑制剂-1(TIMP-1)的水平及可能临床意义。方法 选取住院CAPD及临床符合诊断慢性肾脏病(CKD)患者135例,分为CKD3、CKD4、CKD5期组和CAPD组,其中CAPD组68例;记录患者年龄、腹透龄等临床资料,收集并记录患者的血红蛋白(HB)、血清清蛋白(ALB)、血钙、血磷、甲状旁腺激素(PTH)、血肌酐等指标;血清MMP-10、MMP-8、TIMP-1检测采用酶联免疫吸附试验。结果 CAPD患者血清MMP-10、MMP-8、TIMP-1、血磷、钙磷乘积水平明显高于CKD3、4、5期患者,CAPD组血钙水平较CKD5期组高,差异有统计学意义(P<0.05);Spearman直线相关分析结果提示MMP-10与血磷、钙磷乘积呈正相关,与ALB呈负相关,MMP-8与血磷、hs-CRP、血沉、钙磷乘积呈正相关,TIMP-1与血磷呈正相关;上述3项指标均与血钙、年龄、PTH、腹透龄、血肌酐、HB不具有相关性。CAPD组中的高磷组MMP-10、MMP-8、TIMP-1水平较正常血磷组升高,钙磷乘积增高组较钙磷乘积正常组MMP-10、MMP-8、TIMP-1浓度高,但组间比较仅MMP-10水平差异有统计学意义。结论 CAPD患者血清 MMP-10、MMP-8、TIMP-1、血磷、钙磷乘积水平较透析前CKD患者明显升高;CAPD患者血清MMP-10、MMP-8、TIMP-1水平可能与钙磷代谢有关。     

Outcomes of secondary hyperparathyroidism in chronic kidney disease and the direct costs of treatment

BACKGROUND: There has been an emphasis over the last several years to identify and treat chronic kidney disease (CKD) and its complications as they evolve rather than waiting until the patient reaches end-stage renal disease (ESRD), also known as CKD stage 5. The number of patients who will be identified and prescribed therapies for complications such as secondary hyperparathyroidism (SHPT) is greater than initially proposed. OBJECTIVE: To review the pathways, complications, management, and estimated treatment costs of CKD-related SHPT. METHODS: An electronic literature search of MEDLINE (January 1980 through January 2007) was conducted for English-language publications using the base search term secondary hyperparathyroidism. To refine subsequent searches, the authors added Boolean operators to the following secondary and tertiary search terms: parathyroid hormone, chronic kidney disease, renal osteodystrophy, adynamic bone disease, vascular calcification, cardiovascular disease, vitamin D, vitamin D analogs, hypercalcemia, hyperphosphatemia, calcimimetics, costs, prevalence, and economics. RESULTS: The initial MEDLINE search produced 278 relevant articles. After refining the search terms, the authors triaged the results for English-language publications relevant to the discussion of SHPT and its complications in CKD, eliminating 149 publications. The remaining 129 publications were accepted for review. These articles represent a growing body of primarily observational evidence that demonstrates that elevated intact parathyroid hormone (PTH) levels cause deleterious physiological results across a variety of organ systems, including the cardiovascular and skeletal systems. Specific complications associated with SHPT are left ventricular hypertrophy (LVH), renal osteodystrophy (ROD), and extraskeletal calcification. Medical management of the PTH/vitamin D/calcium and phosphorus imbalances in SHPT focus on regulating PTH levels via vitamin D therapy. The class of calcimimetics is a newer treatment modality that has favorable effects on biochemical laboratory values, such as serum calcium and phosphorus levels, but current data do not show differences on hard endpoint patient-oriented outcomes compared with standard generic agents. The direct drug costs in April 2007 U.S. dollars of treating CKD-associated elevations in PTH in predialysis patients range from $8.40 per patient per week ($437 per year) for oral generic calcitriol to $88.90 per patient per week ($4,623 per year) for oral paricalcitol (expressed as 85% of average wholesale price [AWP] for brand drugs or 70% of AWP for generic drugs). The direct drug costs of treating SHPT in hemodialysis patients range from $80.20 per patient per week ($4,170 per year) for generic calcitriol (IV) to $278.46 per patient per week ($14,480 per year) for oral cinacalcet. CONCLUSIONS: SHPT causes skeletal and cardiovascular complications in CKD patients. Calcitriol therapy is effective in managing PTH levels, but efforts to reduce the associated hypercalcemia and hyperphosphatemia have led to the development of newer, yet more expensive, vitamin D analogs. With the lack of evidence to support comparative superior outcomes in end-organ disease among SHPT therapy alternatives, future research is still needed to clearly identify which newer agents are most competitive with the historical gold standard of calcitriol therapy.     

Vitamin D receptor activator selectivity in the treatment of secondary hyperparathyroidism: understanding the differences among therapies

Secondary hyperparathyroidism (SHPT) is a common and serious consequence of chronic kidney disease (CKD). SHPT is a complex condition characterised by a decline in 1,25-dihydroxyvitamin D and consequent vitamin D receptor (VDR) activation, abnormalities in serum calcium and phosphorus levels, parathyroid gland hyperplasia, elevated parathyroid hormone (PTH) secretion, and systemic mineral and bone abnormalities. There are three classes of drugs used for treatment of SHPT: (i) nonselective VDR activators or agonists (VDRAs); (ii) selective VDRAs; and (iii) calcimimetics. The VDRAs act on the VDR, whereas the calcimimetics act on the calcium-sensing receptor. Calcimimetics are commonly used in conjunction with VDRA therapy. By virtue of the differences in their chemical structure, the nonselective and selective VDRAs differ in their effects on gene expression, and ultimately parathyroid gland, bone and intestine function. Medications in all three classes are effective in suppression of PTH; however, clinical studies show that calcimimetics are associated with an unfavourable tolerability profile and hypocalcaemia, whereas nonselective VDRAs, and to a lesser extent selective VDRAs, are associated with dose-limiting hypercalcaemia and hyperphosphataemia. Selective VDRAs also have minimal undesirable effects on calcium absorption in the intestine, and calcium and phosphorus mobilisation in the bone compared with nonselective VDRAs. Calcium load in patients with CKD can lead to vascular calcification, accelerated progression of cardiovascular disease and increased mortality. High serum phosphorus levels are also associated with adverse effects on cardiorenal function and survival. Recent evidence suggests that VDRAs are associated with a survival benefit in CKD patients, with a more favourable effect with selective VDRAs than nonselective VDRAs. Paricalcitol, a selective VDRA, is reported to exert specific effects on gene expression in various cell types that are involved in vascular calcification and the development of coronary artery disease. This article examines the molecular mechanisms that determine selectivity of VDRAs, and reviews the evidence for clinical efficacy, safety and survival associated with the three drug classes used for treatment of SHPT in CKD patients.     

Emerging drugs for secondary hyperparathyroidism

Introduction: Secondary hyperparathyroidism (SHPT), a common, serious, and progressive complication of chronic kidney disease (CKD), is characterized by elevated serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and mineral metabolism abnormalities. These disturbances may result in CKD–mineral and bone disorder (CKD-MBD), which is associated with poor quality of life and short life expectancy.

Areas covered: The goal of SHPT treatment is to maintain PTH, calcium, and phosphorus within accepted targeted ranges. This review highlights the pathogenesis of SHPT and current SHPT therapeutic approaches, including the use of low-phosphate diets, phosphate binders, 1,25-dihydroxyvitamin D₃ (calcitriol) and its analogs, calcimimetics, and parathyroidectomy in addition to discussing emerging drugs in development for SHPT.

Expert opinion: Numerous studies indicate that mineral abnormalities occur early in the course of CKD, are prevalent by the time patients enter dialysis, and foreshadow a risk of cardiovascular and all-cause mortality. Several newly developed compounds may potentially overcome the limitations of current SHPT therapies. If emerging therapies can reduce PTH, normalize mineral metabolism, promote treatment adherence, and reduce the risk of side effects, they may provide the requisite features for improving long-term outcomes in patients with SHPT receiving dialysis and reduce the risks of CKD-MBD.