[CKD-MBD (Chronic Kidney Disease-Mineral and Bone Disorder). Role of cinacalcet in the treatment of CKD-MBD].

Cinacalcet, a calcium receptor modulator, reduces serum phosphate levels as well as parathyroid hormone (PTH) and serum calcium levels, and improve the control of mineral metabolic disorder, which is a major problem by the active vitamin D sterols in the treatment of secondary hyperparathyroidism. In addition, cinacalcet could improve achievement of the biochemical targets for chronic kidney disease, bone and mineral disorder (CKD-MBD) recommended by K/DOQI and Japanese society for dialysis and therapy (JSDT) guidelines. Some clinical studies clarified the improvement of reduction in PTH levels and achievement targets for serum calcium and phosphate levels by the combined therapy with cinacalcet and vitamin D sterols, such as OPTIMA or ACHIEVE study. However, the effect of therapy may be different which medicine would be used mainly, further examination about the way to combine these two medicines is required. From the results of some experimental and clinical examinations, cinacalcet may have some efficiency on the prevention or regression of the parathyroid hyperplasia, onset of cardiovascular disease and ectopic calcification, prevention of bone fracture, and improvement of bone metabolism or mortality. Various efficient role of cinacalcet in the treatment of CKD-MBD would be elucidated if results of the clinical studies ongoing now, such as EVOLVE and ADVANCE or MBD-5D planning in Japan, will be published in the near future.