Avoiding the risks of secondary hyperparathyroidism in chronic renal failure: A new approach, and a review

Secondary hyperparathyroidism is common in chronic renal failure and is associated with significant clinical risks, including risks for renal bone disease, cardiovascular disease, and death, as well as less frequently recognized neurotoxicities and endocrinopathies. Hormone replacement therapy with vitamin D analogs offers an excellent approach to reduce these diverse risks. Until recently, the clinical use of vitamin D has been hampered by the relatively low therapeutic index of available products. New vitamin D analogs (paricalcitol and doxercalciferol) have been developed and approved, offering nephrologists the opportunity to manage calcitriol deficiency and its many risks more safety and effectively. Hormone replacement therapy-with these new vitamin D analogs may provide renal patients with physiologic levels of active vitamin D metabolites that approximate the normal, healthy state. In particular, doxercalciferol offers the potential for vitamin D hormone replacement therapy utilizing a controlled-release approach that more closely mimics the normal physiologic state.