At present, new compounds are available to treat
secondary hyperparathyroidism, namely calcimimetics, novel
phosphorus binders and also novel
vitamin D receptor activators. Calcimimetics increase the sensitivity of the parathyroid gland to
calcium through spatial configurational changes of the
calcium-sensing receptor. In addition, experimental studies have demonstrated that calcimimetics also upregulate both the
calcium-sensing receptor and the
vitamin D receptor. They are efficacious in children, though the experience in paediatric
chronic kidney disease is still limited.
Sevelamer,
lanthanum carbonate and
magnesium iron hydroxycarbonate are novel
phosphorus binders available on the market. Several studies have demonstrated their efficacy and safety up to 6 years, though costs are the main limitation for a wider use. Since almost all the experience available on the new
phosphorus binders comes from its use in adults, studies on children are needed in order to confirm the efficacy and safety of these products. Other new
salts and
polymers are also being developed. New
vitamin D receptor activators, such as
paricalcitol, are as effective at suppressing
parathyroid hormone (PTH) as the traditional
vitamin D receptor activators used for the past two decades, but they have a better and safer profile, showing fewer calcaemic and phosphoraemic effects while preserving the desirable effects of the
vitamin D receptor activators on the cardiovascular system,
hypertension,
inflammation and
fibrosis. Their use in children with
chronic kidney disease has revealed similar responses to those of adults. The novel compounds discussed in this review should facilitate and improve the management of
mineral and bone disorders in children with
chronic kidney disease.