Two cases of secondary hyperparathyroidism in patients with chronic kidney disease treated with long-term dialysis with dramatic course. Is everything we have done for these patients?

Abstract

Typical bone complications in patients with impaired kidney are associated to the increased bone metabolism, caused by secondary hyperparathyroidism. In this report two cases of the advanced hyperparathyroidism in dialysed patients with end-stage kidney disease are presented. In both cases high bone turnover and dramatic course over the period of long-term follow-up was observed; in both patients multidirectional treatment was commenced including calimimetics, however, the outcome of the therapy was proved unsuccessful. Novel approach for the treatment of patients with end-stage kidney disease is necessary and may include both calicmimetics and/or vitamin D receptor activators. At the same time we present hypothetical conception of treatment with paricalcitol connected with J₁₃₁ which can caused non-operative involution of parathyroid gland. We should consider this idea, although it would require an appropriate course of synthesis and research.