Treatment of secondary hyperparathyroidism with vitamin D derivatives and calcimimetics before and after start of dialysis

Chronic renal failure is almost always associated with secondary uraemic hyperparathyroidism. Action should be taken as early as possible to avoid it or reduce its severity in patients with chronic kidney disease (CKD). Over the last decade, the most effective way of achieving this has been defined as therapy with active vitamin D derivatives. However, the so-called 'non-hypercalcaemic' vitamin D derivatives, which are said to be superior, have not met our expectations so far. In contrast, calcimimetic agents, the new class of compounds that act specifically on the calcium-sensing receptor, are very promising for the treatment and prevention of hyperparathyroidism. CKD is associated with disturbances in calcium, phosphate, and vitamin D metabolism that occur early in the course of renal disease. In most patients, these disturbances lead to secondary hyperparathyroidism and osteitis fibrosa or associated, more complex, skeletal lesions. Here, we focus on recent advances in the prevention and treatment of secondary hyperparathyroidism by vitamin D derivatives and by calcimimetic agents.