Treating hyperparathyroidism with cinacalcet HCl (Sensipar[R]).(Clinical Consult)(hydrochloride)

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...clinical information is needed to monitor their response to therapy?

A: The complexities of balancing the many regulatory functions lost in kidney failure are certainly evident in the efforts to manage hyperparathyroidism associated with ESRD. Standard therapy for secondary hyperparathyroidism previously included dietary phosphorus restriction, calcium and non-calcium based phosphate binders, and vitamin D analogs. This combination therapy enabled clinicians to successfully suppress PTH levels to NKF-K/DOQI target ranges. Unfortunately the supraphysiologic dosing of 1,25- dihydroxy Vitamin D or its analogs required for PTH suppression has frequently caused intestinal overabsorption of both calcium and phosphorus then evident in excessive serum levels (Goodman et al., 2000; Sprague, Llach, Amdahl, Taccetta, & Baffle, 2003). The resulting hypercalcemia and hyperphosphatemia then require treatment with additional, costly non-calcium containing phosphate binders.

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