Paricalcitol in the treatment of secondary hyperparathyroidism

Secondary hyperparathyroidism is a common complication of both chronic kidney and end-stage renal disease. Vitamin D appears to play a central role in the pathogenesis of this condition and active vitamin D replacement is usually a necessary component of its treatment. The ability to administer active vitamin D is limited by increases in calcium and phosphorus, predisposing patients to vascular calcifications and cardiovascular disease. Paricalcitol is a new vitamin D analog designed to suppress parathyroid secretion with less effect on serum levels of calcium and phosphorus. The application of paricalcitol in chronic kidney disease may slow the clinical course of secondary hyperparathyroidism and allow more effective suppression of parathyroid hormone while minimizing the concommitant risks of hypercalcemia and hyperphosphatemia. This article reviews the pathogenesis of secondary hyperparathyroidism and the data supporting the role of oral and intravenous paricalcitol in the treatment of secondary hyperparathyroidism in both chronic kidney disease and end-stage renal disease patients.