| Theme | New frontiers of calcimimetics | |
|---|---|---|
| Title | Parathyroidectomy and calcimimetics | |
| Publish Date | 2018/09 | |
| Author | Takatoshi Kakuta | Division of Nephrology, Endocrinology and Metabolism, Department of Medicine, Tokai University Hachioji Hospital |
| [ Summary ] | Secondary hyperparathyroidism (SHPT) remains a serious complication in patients with chronic kidney disease. It has a considerable impact on mortality through the development of high turnover bone disease and vascular calcification. Conventional treatment for SHPT includes phosphate binders and vitamin D receptor activators (VDRAs). However, these treatments do not always provide adequate control of SHPT, particularly for patients with advanced parathyroid hyperplasia where the expression of calcium-sensing receptors and vitamin D receptors is reduced. Even after the introduction of cinacalcet hydrochloride, there remain a segment of patients for whom SHPT cannot be managed with medical treatment. The annual number of parathyroidectomies for SHPT and THPT in Japan increased from 2004 to 2007 and then decreased markedly after 2007, with 303 operations performed in 2015. On the other hand, parathyroidectomies (PTx) drastically improve biochemical parameters and clinical symptoms related to severe secondary hyperparathyroidism (SHPT). Some patients still require parathyroidectomies. It is necessary for PTx to be used in conjunction with other medical treatments. | |