[Chronic kidney disease (CKD) and bone. The clinical perspective of parathyroid interventional therapy for advanced secondary hyperparathyroidism in the era of cinacalcet HCl].

Advanced secondary hyperparathyroidism (SHPT) due to chronic kidney disease refractory to medical treatment should be indicated for parathyroid interventional therapy (parathyroidectomy [PTX] and percutaneous ethanol injection therapy [PEIT] ect). Japanese Society of Dialysis Therapy (JSDT) guideline recommends performing PTX at relatively early stage of SHPT in order to improve patient's mortality. Cinacalcet HCl should influence the treatment of SHPT in our country. Because PTX can dramatically control SHPT and majority of Japanese dialysis patients have to continue hemodialysis for long-term, PTX should be performed in patients in whom SHPT is refractory to vitamin D therapy, moreover and Cinacalcet HCl and can not tolerate to continue Cinacalcet HCl due to side effects. However surgeons hesitate the operation for patients who belong to high risk group and have the possibility of severe complications, suffer from parathyroid carcinoma or parathyromatosis. Cinacalcet HCl may be indicated for these patients. SHPT can be managed for long-term by PEIT, provided that only one parathyroid gland is enlarged. Indication of PEIT may be limited by Cinacalcet HCl.