The clinical consequences of secondary hyperparathyroidism: focus on clinical outcomes.
Secondary hyperparathyroidism (SHPT) is a common occurrence in patients with chronic renal failure and is characterized by excessive serum parathyroid hormone (PTH) levels, parathyroid hyperplasia and imbalances in calcium and phosphorus metabolism. PTH acts as a uraemic toxin and it may be responsible for the following long-term consequences: renal osteodystrophy; non-skeletal abnormalities, including severe vascular and heart valve calcification; alterations in cardiovascular structure and function; immune dysfunction; and renal anaemia. The risk of developing SHPT is not the same for all uraemic patients. Black patients appear to have a higher risk of developing SHPT than Caucasian patients, and patients with diabetes have a lower risk than non-diabetic patients. Current treatments include dietary phosphate restriction, oral phosphate binders, vitamin D and its analogues, and, in severe cases, parathyroidectomy. These treatments do not provide optimal treatment for many patients, and compounds that directly inhibit PTH secretion may prove a major step forward in the treatment of SHPT.
Division of Nephrology and Dialysis, Department of Medicine III, University Hospital, Vienna, Austria. walter.hoerl@nephro.imed3.akh-wien.ac.at
Walter H
WH
Hörl
D000818:Animals; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D002423:Cause of Death; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000209:etiology; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D012307:Risk Factors; D014511:Uremia / Q000150:complications*
D010281:Parathyroid Hormone; D010758:Phosphorus