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Medical Student
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Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Research/Clinical
Abstract
Background: Secondary hyperparathyroidism (SHPT) is a major complication of chronic kidney disease (CKD). Bone disease, vascular calcification, and cardiovascular morbidity are all areas where the effects of secondary hyperparathyroidism are seen. Pharmacological management has had many advances such as vitamin D analogs and calcimimetics. They have introduced tailored approaches to SHPT treatment. This systematic review examines the efficacy and safety of these therapies across different CKD stages with an emphasis on patient-centered outcomes.
Methods: A comprehensive review was conducted using PubMed, Elsevier, and Cochrane databases. Search terms included “chronic kidney disease stage,” “vitamin D analogs,” “secondary hyperparathyroidism,” and “calcimimetic.” Initial search yielded 79 articles. Inclusion criteria included primary research, case reports, and systematic reviews. Review articles were excluded. This yielded 35 articles. We evaluated the effects of vitamin D analogs and calcimimetics on biochemical, skeletal, cardiovascular, and survival outcomes in CKD stages 3-5D and ESRD.
Results: Vitamin D Analogs: Paricalcitol and other selective vitamin D receptor activators were able to reduce PTH levels by 25%-50% in CKD stages 3-5D. Along with this reduction there was increases in serum calcium and phosphorus which increased vascular calcification risks. However, intravenous vitamin D administration minimized hypercalcemia compared to oral regimens. Calcimimetics: Cinacalcet reduced PTH levels by approximately 50%-60% in advanced CKD. Some evidence suggests decreased vascular calcifications and improved outcomes in calciphylaxis. Amongst dialysis patients self-administering cinacalcet there was issues with gastrointestinal side effects and poor adherence. Cinacalcet was also found to reduce the need for parathyroidectomy by 51%. However, its effects on mortality and cardiovascular health weren’t found. Combination Therapies: When both were combined calcimimetics and vitamin D analogs showed better PTH suppression and reduced cardiovascular risks compared to monotherapy. Surgical Interventions: Parathyroidectomy is an effective tool in refractory SHPT cases, but it carries significant perioperative risks.
Conclusions: Vitamin D analogs and calcimimetics remain central to SHPT management in CKD patients. Despite their efficacy, risks such as hypercalcemia, hypocalcemia, and adherence issues persist. Combination therapies offer promise but require further validation. Future research should emphasize long-term outcomes and individualized treatment strategies to improve survival and quality of life.
Recommended Citation
Shaju, Ronald A.; Sepulveda, Alyssa L.; Gutierrez, Yolanda V.; and Cruz, Melissa M., "Advances in Vitamin D Analogs and Calcimimetics for Secondary Hyperparathyroidism in Chronic Kidney Disease" (2025). Research Symposium. 136.
https://scholarworks.utrgv.edu/somrs/2025/posters/136
Included in
Advances in Vitamin D Analogs and Calcimimetics for Secondary Hyperparathyroidism in Chronic Kidney Disease
Background: Secondary hyperparathyroidism (SHPT) is a major complication of chronic kidney disease (CKD). Bone disease, vascular calcification, and cardiovascular morbidity are all areas where the effects of secondary hyperparathyroidism are seen. Pharmacological management has had many advances such as vitamin D analogs and calcimimetics. They have introduced tailored approaches to SHPT treatment. This systematic review examines the efficacy and safety of these therapies across different CKD stages with an emphasis on patient-centered outcomes.
Methods: A comprehensive review was conducted using PubMed, Elsevier, and Cochrane databases. Search terms included “chronic kidney disease stage,” “vitamin D analogs,” “secondary hyperparathyroidism,” and “calcimimetic.” Initial search yielded 79 articles. Inclusion criteria included primary research, case reports, and systematic reviews. Review articles were excluded. This yielded 35 articles. We evaluated the effects of vitamin D analogs and calcimimetics on biochemical, skeletal, cardiovascular, and survival outcomes in CKD stages 3-5D and ESRD.
Results: Vitamin D Analogs: Paricalcitol and other selective vitamin D receptor activators were able to reduce PTH levels by 25%-50% in CKD stages 3-5D. Along with this reduction there was increases in serum calcium and phosphorus which increased vascular calcification risks. However, intravenous vitamin D administration minimized hypercalcemia compared to oral regimens. Calcimimetics: Cinacalcet reduced PTH levels by approximately 50%-60% in advanced CKD. Some evidence suggests decreased vascular calcifications and improved outcomes in calciphylaxis. Amongst dialysis patients self-administering cinacalcet there was issues with gastrointestinal side effects and poor adherence. Cinacalcet was also found to reduce the need for parathyroidectomy by 51%. However, its effects on mortality and cardiovascular health weren’t found. Combination Therapies: When both were combined calcimimetics and vitamin D analogs showed better PTH suppression and reduced cardiovascular risks compared to monotherapy. Surgical Interventions: Parathyroidectomy is an effective tool in refractory SHPT cases, but it carries significant perioperative risks.
Conclusions: Vitamin D analogs and calcimimetics remain central to SHPT management in CKD patients. Despite their efficacy, risks such as hypercalcemia, hypocalcemia, and adherence issues persist. Combination therapies offer promise but require further validation. Future research should emphasize long-term outcomes and individualized treatment strategies to improve survival and quality of life.
