Avoiding the risks of secondary hyperparathyroidism in chronic renal failure: A new approach, and a review

Secondary hyperparathyroidism is common in chronic renal failure and is ass ociated with significant clinical risks, including risks for renal bone dis ease, cardiovascular disease, and death, as well as less frequently recogni zed neurotoxicities and endocrinopathies. Hormone replacement therapy with vitamin D analogs offers an excellent approach to reduce these diverse risk s. Until recently, the clinical use of vitamin D has been hampered by the r elatively low therapeutic index of available products. New vitamin D analog s (paricalcitol and doxercalciferol) have been developed and approved, offe ring nephrologists the opportunity to manage calcitriol deficiency and its many risks more safety and effectively. Hormone replacement therapy-with th ese new vitamin D analogs may provide renal patients with physiologic level s of active vitamin D metabolites that approximate the normal, healthy stat e. In particular, doxercalciferol offers the potential for vitamin D hormon e replacement therapy utilizing a controlled-release approach that more clo sely mimics the normal physiologic state.