Basic and clinical aspects of calcimimetics. The JSDT guideline and cinacalcet hydrochloride

Abstract

The guidelines for the management of secondary hyperparathyroidism in chronic dialysis patients by Japanese Society of Dialysis Therapy (The JSDT guideline) set the optimal levels of P, Ca and intact-PTH in dialysis patients as 3.5 - 6.0 mg/dL, 8.4 - 10.0 mg/dL, 60 - 180 pg/mL (or whole-PTH 35 - 106 pg/mL) , respectively. Active vitamin D therapy tends to cause the elevation of serum P/Ca levels along with the suppression of parathyroid function. Therefore, it was often difficult to keep P/Ca/PTH within the optimal levels simultaneously by medical therapies. Cinacalcet hydrochloride therapy has a potential to break through the situation since it decreases P/Ca levels while it suppresses parathyroid function.