Calcimimetics in the treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD): current knowledge, new information and future prospects

Calcimimetics (cinacalcet hydrochloride) modulate the calcium-sensing receptor (CaR). The effect means not only suppression of pa­ rathormone secretion but also inhibition of parathyroid activity and growth. Since 2004 (a bit later in the C has been available for the treatment of secondary hyperparathyroidism (SHPT) in patients with kidney failure. Secondary hyperparathyroidism is a unifying moment of chronic kidney disease-mineral and bone disorder (CKD-MBD). The article is concerned with the effect of calcimimetics on individual CKD-MBD components (laboratory, bone and vascular). Large and long-term studies are available, including those from the actual clinical practice, documenting very good effectiveness in the tre­ atment of SHPT. They also have beneficial effects on hyperphosphatemia accompanying kidney failure. The effect on bones is likely; in the nearest future, results of a study assessing histomorphometry prior to and after one year of treatment should be published. Cinacalcet may slow the process of vascular calcification in di ents with full protection against vascular wall calcifications. As of now, cinacalcet has not been approved for the use in SHPT either prior to dialysis or after transplantation. Yet in these areas, data from controlled studies are available. Transplanted patients may benefit from concurrent decrease o increase of phosphate levels (hypophosphatemia treatment) but so far, the experiences have been limited. In the future, CaR is likely to be modulated in other organs, not only in the parathyroids. First reports have appeared on the deve­ lopment of third-generation calcimimetics with potentiated effects in other tissues and organs. Thus, t may be promising for other areas as well.

Keywords: secondary hyperparathyroidism, cinacalcet, calcium-sensing receptor, calcification, calciuria