Secondary hyperparathyroidism (SHPT), commonly encountered in patients receiving maintenance dialysis, is associated with numerous adverse outcomes, including vascular and valvular calcifications, changes in bone metabolism and an increased risk of cardiovascular morbidity and mortality. Calcimimetics, agents that act on the calcium sensing receptor (CaSR), were designed to overcome limitations in the use of vitamin D sterols to treat SHPT, and have demonstrated efficacy in reducing levels of PTH in randomized trials. Currently available calcimimetics include oral cinacalcet (СС) and the recently approved intravenously administered agent, etelcalcetide (ЕС). While СС is an allosteric modulator of the CaSR, ЕС acts as a direct CaSR agonist. Etelcalcetide’s properties allow it to be administered intravenously thrice weekly at the end of a hemodialysis treatment session, which undoubtedly increases adherence to therapy and reduces the burden of using tablet preparations. In randomized clinical trials, EC has been shown to be more effective than CС in reducing levels of PTH, phosphate, calcium, fibroblast growth factor 23 (FGF23). This review compares and contrasts the pharmacologic characteristics of СС and ЕС, discusses the results of clinical trials involving these drugs, and posits implications for their use for clinical practice.

Keywords: сalcimimetics, calcium-sensing receptors, chronic kidney disease–mineral and bone disease (CKD-MBD), etelcalcetide, secondary hyperparathyroidism, cinacalcet, hemodialysis