doi: 10.1093/ndtplus/sfm040 Efficacy of early treatment with calcimimetics in combination with reduced doses of vitamin D sterols in dialysis patients

Vitamin D is an important physiologic regulator of bone andmineralmetabolism. In chronic kidney disease, reduced renal production of calcitriol contributes to secondary hy-perparathyroidism (SHPT).Consequently, supplementation with vitamin D sterols is an important treatment for SHPT and its associated mineral and bone disorders. However, doses of vitamin D sterols required to suppress parathyroid hormone (PTH) secretion often promote hypercalcaemia and hyperphosphataemia. Therefore, there is a trade-off between reduced serum PTH and increased levels of serum calcium, phosphorus and calcium–phosphorus product. It has been suggested that treatment of SHPT with cinacalcet, a type II calcimimetic, with reduced doses of vitamin D sterols could enhance achievement of calcium and phos-phorus treatment targets while maintaining goals for PTH. Recent clinical trials have evaluated this hypothesis and demonstrated that treatment with cinacalcet in combina-tion with reduced doses of vitamin D sterols is an effective treatment for the management of SHPT