[Paricalcitol - a selective vitamin D receptor activator for secondary hyperparathyroidism in patients with chronic...

Secondary hyperparathyroidism is a frequently encountered complication of chronic kidney disease (CKD) attributable to altered phosphate/calcium homeostasis, increased synthesis of phosphaturic hormone (FGF-23) and profound active vitamin D deficiency. The disorder is associated with severe bone disease, progressive cardiovascular calcification and increased mortality. Calctriol and its analogs (alphacalcidol) can suppress parathyroid activity, however at the cost of hypercalcemia and hiperphosphatemia, thus aggravating the vascular disease. During the last decade, selective vitamin D receptor activators (VDRA) have been introduced, that reduce parathyroid activity with minimal changes in calcium and phosphate metabolism. Paricalcitol is the only selective VDRA registered in Europe for the management of patients with different stadia of CKD. For today, with its efficacy and safety confirmed in several clinical trials paricalcitol increases the vitamin D therapeutic window in this population. Furthermore, the clinical data on its possible positive effect on survival together with its reduced or even lacking experimental procalcifying effects on vessels, call for extensive research, since selective VDRA may provide additional clinical benefits going beyond mineral-bone disorder.