THE SIGNIFICANCE OF CINACALCET IN CORRECTION OF PHOSPHORUS-CALCIUM DISBALANCE IN PATENTS WITH CHRONIC KIDNEY DISEASE

Secondary hyperparathyreosis (SHPT) is a common sign of chronic kidney disease (CKD) and leads not only to osteodystrophy, which increases the risk of fractures, but also to outerosteal signs, which include vessel calcification, hypertension, anemia,skin erythema, and sexual dysfunction. Epidemiologic data show the connection between high blood levels of parathormone (PTH), calcium (Ca) and phosphate (P) with higher mortality of the patients. Traditional therapy SHPT in patients on renal replacement therapy vitamin D (VD) and phosphate-binders suppresses secretion of parathormone, but also leads to hypercalciemia and hyperphosphatemia, which therefore leads to ectopic calcification and higher mortality. Therefore in 2004 a new class of medication – calcimimetics (CM), the only representative of which nowadays is cinacalcet (CC) (Mimpara, Sensipar) – was introduced. CC increases the threshold of the reaction of calcium-sensitive receptors of parathyroid gland on blood calcium – the most strong inhibitor of PTH secretion, which leads to decrease of this hormone in blood, decreased resorbtion of Ca and P out of bones and leads to their decrease in blood concentrations. In various investigations was shown that CM can provoke regression of hyperplasia PTG, decreasing the risk of parathyroidectomy. The evidence that CC decreases the severity of uremic osteodystrophy and the frequency of fractures was obtained. Because of the decrease in levels of PTH, blood Ca and P, and also direct action on blood vessels, CC slows down vessel calcinosis. In experimental investigations was shown that CC decreases the severity of arterial hyper pressure, probably because of the direct vasodilatation effect, and also suppression of the rennin secretion. At the endpointthe use of CC decreases the frequency of hospitalizations for the cause of cardiovascular pathology. Nowadays the investigation on the influence of CC on patient survival takes place. The medicine has a good control of SHPT in patients after renal transplantation and allows to avoid parathyroidectomy. In animal experiments with the use of calcimimetics the date on effective decrease of proteinuria and slow progression of the decrease of the glomerular filtration speed were received, which supports the use of CC on the early stages of CKD, but this data needs more clinical evidence. The increasing amount of proven data base of the effective combination CC and low doses of VD in patients on the renal replacement therapy (keeping in mind positive cardiac and nephroprotective effects of the later ones).

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