Hyperparathyroidism (HPT) is a significant clinical concern for patients with a variety of diseases, notably the secondary HPT associated with
chronic kidney disease requiring dialysis. Secondary HPT is associated with elevated para-
thyroid hormone (PTH) levels, decreased levels of 1,25 dihydroxyvitamin D, and disordered
mineral levels (usually high
calcium and
phosphorus). If not controlled, secondary HPT can result in
bone disease,
vascular calcification, and ultimately, patient mortality. Established, conventional
therapies, such as 1,25dihydroxyvitamin D analogues (
vitamin D analogues) and
phosphate binders, have proven to be inadequate in enabling patients to meet the National Kidney Foundation's-
Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) treatment goals for PTH,
calcium and
phosphorus levels. A novel therapeutic,
cinacalcet HCl (formerly
AMG 073;
Sensipar in the US and Mimpara in Europe; Amgen, Inc.), binds directly to the
calcium-sensing receptor (CaR) on the cells of the parathyroid gland, increasing the receptor's sensitivity to
calcium and reducing PTH, serum
calcium and
phosphorus levels. Treatment with
cinacalcet in clinical trials has safely and effectively improved achievement of the NKF-K/DOQI goals.
Cinacalcet has also reduced serum
calcium levels in patients with primary HPT, including
parathyroid carcinoma, in the clinical trial setting. Evidence suggesting the utility of
cinacalcet in these diseases and the potential for additional therapeutic applications will be discussed.