title: Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease.
abstract: Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD) and is part of the CKD-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of fracture and mortality; thus, SHPT control is recommended as kidney function declines. Effective SHPT management becomes more difficult once skeletal and cardiovascular adverse effects associated with severe SHPT have become established. However, interventional studies to lower parathyroid hormone (PTH) have so far shown inconsistent results in improving patient-centred outcomes such as mortality, cardiovascular events and fracture. Pharmacological treatment effect on PTH level is also inconsistent between pre-dialysis CKD and dialysis patients, which adds to the complexity of SHPT management. This review aims to give an overview on the pathophysiology, pharmacological and non-pharmacological treatment for SHPT in CKD including some of the limitations of current therapeutic options.
authors.affiliation: Sheffield Kidney Institute, Sheffield, UK.
authors.forename: S N
authors.initials: SN
authors.lastname: Salam
authors.affiliation: Sheffield Kidney Institute, Sheffield, UK.
authors.forename: A
authors.initials: A
authors.lastname: Khwaja
authors.affiliation: Sheffield Kidney Institute, Sheffield, UK. martin.wilkie@sth.nhs.uk.
authors.forename: M E
authors.initials: ME
authors.lastname: Wilkie
mesh_terms: D004032:Diet; D019468:Disease Management; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000601:surgery / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D010281:Parathyroid Hormone / Q000037:antagonists & inhibitors* / Q000097:blood; D010710:Phosphates / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D