Management of patients with advanced secondary hyperparathyroidism: the Japanese approach

Control of secondary hyperparathyroidism is one of the main objectives in the management of uraemic bone disease [1]. Although early initiation of prophylactic measures and calcitriol pulse therapy [2] in cases with advanced hyperparathyroidism have had a positive impact on patient management, there are still difficulties to select the most appropriate therapy for the individual patient with advanced secondary hyperparathyroidism. The major problem is to identify in time the patient who cannot be controlled by calcitriol and for whom the decision has to be made whether medical management or parathyroidectomy are the most appropriate interventions [3,4]. Despite advances, such as new vitamin D sterols [5], calcimimetics [6,7] or non-aluminium, noncalcium-containing phosphate binders [8], this dilemma persists unabated. We are of the opinion that recent insights into the pathogenetic mechanisms underlying parathyroid hyperplasia [9,10] have greatly helped to make more rational selections of therapy. It is the purpose of this brief communication, to offer to the readers of Nephrology Dialysis Transplantation some information on the unique intervention strategies that we have recently developed in Japan.