[Treatment of secondary hyperparathyroidism in dialysis patients]

Secondary hyperparathyroidism is an important complication in chronic kidney disease (CKD). It is associated with mineral and bone disorders and with increased cardiovascular morbidity and mortality. Despite standard treatment, adequate control of all biochemical targets for CKD-mineral and bone disorder (CKD-MBD) remains suboptimal and is accomplished only in a minority of patients receiving hemodialysis. New insights into the pathogenesis of secondary hyperparathyroidism and the development of new therapeutic agents are offering new possibilities to improve the treatment of this condition in patients with CKD. This article provides an overview of the current understanding of secondary hyperparathyroidism and evidence supporting strategies for its treatment, which is complex and requires multiple interventions. The ''modern'' treatment of secondary hyperparathyroidism in dialysis patients consists of free-calcium and aluminium phosphate binders, vitamin D receptor activators (VDRAs), and calcimimetics, even though calcium- and aluminum-based phosphate binders and calcitriol are not without complications. Additional data are needed to determine the optimal combination of phosphate binders, VDRAs and calcimimetics, and to establish how such therapeutic tools impact on cardiovascular events and survival and whether there are differences between VDRAs and calcimimetics in this respect.