Clinical features and new perspectives on follow-up and treatment of secondary hyperparathyroidism in patients with chronic kidney disease

Abstract With the global prevalence of chronic kidney disease (CKD), the incidence of secondary hyperparathyroidism (SHPT) has gradually increased. The SHPT increase cardiovascular morbidity and mortality in patients with CKD. However, clinical observations have found that SHPT in CKD patients has not attracted sufficient attention from clinicians. Therefore, our study investigated the current status of treatment of SHPT patients with CKD and found that 86.3% of patients had substandard parathyroid hormone (PTH) according to the KDOQI guidelines, and 44.5% of SHPT patients requiring pharmacologic or surgical interventions were not appropriately treated according to the KDIGO guidelines. Additionally, we analyzed the clinical characteristics of SHPT patients with CKD and found that PTH levels were lower in elderly, diabetic nephropathy patients, eGFR and adjusted serum calcium ion concentration were independent risk factors for increased PTH, and dialysis improved serum hypocalcemia better than hyperphosphatemia. Based on these findings, we propose some new recommendations for the follow-up and treatment of SHPT patients with CKD.