New therapies: calcimimetics, phosphate binders and vitamin D receptor activators

Abstract

At present, new compounds are available to treat secondary hyperparathyroidism, namely calcimimetics, novel phosphorus binders and also novel vitamin D receptor activactors. Calcimimetics increase the sensitivity of the to parathyroid gland to calcium through spacial configurational changes of the calcium-sensing receptor. In addition experimental studies demonstrated that calcimimetic also upregulate the calcium-sensing receptor and the vitamin D receptor. They are efficacious in children, though the experience in pediatric chronic kidney disease is still limited. Sevelamer, lanthanum carbonate and magnesium iron hydroxicarbonate are novels phosphorus binders available in the market. Several studies have demonstrated their efficacy and safety though costs are the main limitation for a wider use. Other new salts and polymers are also in development. New vitamin D receptor activators such as paricalcitol are as effective suppressing PTH as the traditional vitamin D receptor activators used during the last two decades but they have a better and safer profile showing less calcemic and phosphoremic effects while preserving the desirable effects of the vitamin D receptor activators on the cardiovascular system, hypertension, inflammation and fibrosis. The use of them in children with chronic kidney disease demonstrated similar response than in adults. The novel compounds discussed in this review should facilitate and improve the management of mineral and bone disorders in children with chronic kidney disease.