Management of Secondary Hyperparathyroidism in Stages 3 and 4 Chronic Kidney Disease

Andress, Dennis L.; Coyne, Daniel W.; Kalantar‐Zadeh, Kamyar; Molitch, Mark E.; Zangeneh, Farhad; Sprague, Stuart M.

doi:10.4158/ep.14.1.18

Cited by 49 publications

(36 citation statements)

References 60 publications

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“…The present study demonstrated that 85.14% patients with CKD had elevated serum PTH expression levels, which was similar to that in previous reports (7,19). Andress et al (7) reported that ~40% patients with CKD stage 3 and 80% of patients with CKD stage 4 are affected by SHPT. Drüeke (19) reported that SHPT is observed in 20-80% patients with CKD, depending on the stages of the disease.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Wei

Lin

Yang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD), and its development and progression are affected by various factors. The aim of the present study was to identify the risk factors for SHPT in patients with CKD. A retrospective study was performed in 498 patients (305 males and 193 females) with CKD, observed in the The First Hospital of Jilin University between January 2008 and December 2012. The demographic, clinical and laboratory data were collected. Patients were divided into the SHPT group (n=424) with elevated serum parathyroid hormone (PTH) expression levels and the control group (n=74) with normal serum PTH expression levels. Univariate and multivariate regression analyses were employed to explore the risk factors for SHPT. Serum PTH expression levels in women with CKD were significantly higher than in men (P= 0.047). Serum PTH expression levels were positively correlated with the expression levels of serum creatinine (P<0.01), phosphorus (P<0.01), C-reactive protein (P<0.05), triglyceride (P<0.05), cholesterol (P<0.05) and low-density lipoprotein cholesterol (P<0.05), but were negatively correlated with the expression levels of hemoglobin (P<0.05), calcium (P<0.01) and CO 2 combining power (P<0.01) in patients with CKD. Multivariate analysis showed that the serum expression levels of creatinine [µmol/l; odds radio (OR), 1.003; 95% confidence interval (CI), 1.002-1.004; P=0.001] and phosphorus (mmol/l; OR, 2.19; 95% CI, 1.254-3.826; P=0.006) in patients with CKD significantly influenced serum PTH expression levels. The SHPT risk factors include female gender, low calcium, high phosphorus, acidosis, anemia, hypertension, hyperlipidemia and micro-inflammation, with blood phosphorus and creatinine being independent risk factors. IntroductionThe incidence of chronic kidney disease (CKD) is rapidly increasing, posing a serious health problem worldwide. More than 16 million adults are affected by end stage CKD in the USA (1,2). Abnormal serum calcium, phosphorus and parathyroid hormone (PTH) expression levels are common challenges in the management of CKD (3,4). These biochemical abnormalities, together with the dysregulation of vitamin D metabolism and bone turnover, constitute a systemic syndrome termed CKD mineral and bone disorder (CKD-MBD) (5).Secondary hyperparathyroidism (SHPT) is a common complication of patients with CKD, which is characterized by increased blood PTH levels, and abnormal mineral and bone metabolism (6). It is associated with increased morbidity and mortality, and adversely influences the quality of life of patients with CKD (3,6). The incidence of SHPT is reported to increase with the stage of CKD: 40% in stage 3, 70% in stage 4 and >80% in stage 5 (4,7).The kidneys are vital organs regulating calcium and phosphorous homeostasis (8). SHPT is an adaptive pathophysiological process in response to deteriorating renal insufficiency (6). The fundamental mechanism of PTH in kidneys is to suppress the reabsorption of phosphate in the pro...

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Section: Discussionmentioning

confidence: 99%

“…It is associated with increased morbidity and mortality, and adversely influences the quality of life of patients with CKD (3,6). The incidence of SHPT is reported to increase with the stage of CKD: 40% in stage 3, 70% in stage 4 and >80% in stage 5 (4,7).…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Wei

Lin

Yang

et al. 2016

Experimental and Therapeutic Medicine

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“…These less favorable effects of 1,25(OH) 2 D 3 therapy have spurred the development of active vitamin D analogues that retain the therapeutically important properties of VDRA but have less calcemic activity (18). The term "selective" VDRA, usually applied to paricalcitol and maxacalcitol (19), indicates that the vitamin D receptors in the gastrointestinal (GI) tract are less activated than in other organs, leading to lower GI absorption of calcium and phosphorus with subsequent less hypercalcemic or hyperphosphatemic effects, while the salutary vitamin D receptor activation in other organs is maintained.…”

Section: Vitamin D Agents Available For Therapeutic Interventionsmentioning

confidence: 99%

Clinical Outcomes with Active versus Nutritional Vitamin D Compounds in Chronic Kidney Disease

Kalantar-Zadeh

Kövesdy

2009

Clinical Journal of the American Society of Nephrology

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“…6 Nodular hyperplasia is usually present in patients with higher concentrations of serum COOH-terminal immunoreactive PTH. 16 These findings suggest that nodular hyperplasia represents an advanced stage of hyperplasia and is present in patients with more severe stages of hyperparathyroidism. Abundant numbers of apoptotic cells were found in nodular SHPT samples in the present study.…”

Section: Discussionmentioning

confidence: 96%

Calcium-sensing receptor and apoptosis in parathyroid hyperplasia of patients with secondary hyperparathyroidism

et al. 2013

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Management of Secondary Hyperparathyroidism in Stages 3 and 4 Chronic Kidney Disease

Cited by 49 publications

References 60 publications

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease

Clinical Outcomes with Active versus Nutritional Vitamin D Compounds in Chronic Kidney Disease

Calcium-sensing receptor and apoptosis in parathyroid hyperplasia of patients with secondary hyperparathyroidism

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