Lecture Code : IS04-S1
Session Name : Industry Symposium 4 (DKSH)
Session Topic : Industry Symposium 4 (DKSH)
Date & Time, Place : June 12 (Fri) / 12:00-12:40 / Room 2 (GBR 102), 1F

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Optimal Management of SHPT in Dialysis Patients: Clinical Benefits and Experience with Evocalcet

Hirotaka Komaba
Tokai University School of Medicine, Japan

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Secondary hyperparathyroidism (SHPT) is a key component of CKD-MBD and is associated not only with high-turnover bone disease and cortical porosity, but also with systemic complications, ultimately contributing to adverse clinical outcomes. Therefore, optimal management of SHPT is central to improving patient prognosis. Although the current KDIGO guideline suggests an upper target for intact PTH of up to nine times the upper limit of normal (approximately 600 pg/mL), accumulating evidence indicates that these deleterious effects may occur even at substantially lower PTH levels. Over the past two decades, the medical management of SHPT has evolved considerably with the advent of calcimimetics. In Japan, where the JSDT CKD-MBD guidelines were updated in late 2025, a more proactive approach with earlier and more intensive PTH control is commonly adopted compared with other countries. While cinacalcet has demonstrated robust efficacy, its clinical use is sometimes limited by gastrointestinal adverse effects. Evocalcet has emerged as an alternative that may overcome these limitations, offering improved tolerability and more consistent PTH control. In this presentation, I will review current strategies for the optimal management of SHPT in dialysis patients and discuss the clinical benefits of evocalcet based on real-world experience in Japan. Particular emphasis will be placed on appropriate patient selection and timing of intervention, highlighting a more proactive and individualized approach to SHPT management with the potential to improve long-term outcomes.

Keywords: Calcimimetics, CKD-MBD, PTH, secondary hyperparathyroidism