Though the prevalence of
secondary hyperparathyroidism (SHP) and the related
mineral metabolism (MM) changes have been reported at almost the same rate in
peritoneal dialysis (PD) as in
hemodialysis (HD) patients, PD patients have a higher prevalence of adynamic
bone disease (ABD), suggesting that their bone is less sensitive for a given level of PTH. Furthermore, the
phosphorus control seems to be better and
vitamin D deficiency is more common in PD patients than in HD patients. So, the therapeutic approach to SHP and MM changes in PD patients might be different from the one applied to HD patients.
Vitamin D metabolites and
phosphate binders, though effective in controlling SHP of CKD patients, are not equally effective in controlling at the same extent
calcium and/or
phosphorus levels. Recently, a new
drug (
Cinacalcet) has been introduced in the clinical practice which significantly increased the chance of obtaining a simultaneous control of both PTH and MM parameters. However, only scanty data are present in the literature regarding the use of
Cinacalcet in PD patients. The few studies produced in PD retraced the results obtained in
hemodialysis patients, confirming that both in the short- and long-term
Cinacalcet induced a more pronounced reduction of PTH in a larger percentage of patients as compared with standard
therapy (ST), and this effect was associated with a decrease in both
calcium and
phosphorus concentrations, though the extent of the percentage decrease of
phosphorus was lower than in HD patients. The safety/tolerability profile was again the same as in HD patients, with gastrointestinal symptoms representing the more frequently reported side effects. In our experience, given that a severe form of SHP is less frequent, the control of
phosphate is usually better and
vitamin D deficiency is more frequent in PD than in HD patients, making the former patients more prone to hypo- rather than
hypercalcemia, the need for the use of the most recent and potent drugs for the control of SHP, including
Cinacalcet, is usually lower in PD than in HD patients.